Simulations for Designing and Interpreting Intervention Trials in Infectious Diseases

M. Elizabeth Halloran, Kari Auranen, Sarah Baird, Nicole E. Basta, Steve Bellan, Ron Brookmeyer, Ben Cooper, Victor DeGruttola, James Hughes, Justin Lessler, Eric T. Lofgren, Ira M. Longini, Jukka-Pekka Onnela, Berk Ozler, George Seage, Thomas A. Smith, Alessandro Vespignani, Emilia Vynnycky, Marc Lipsitch

bioRxiv

September 15, 2017

ABSTRACT

Here we urge the adoption of a new paradigm for the design and interpretation of intervention trials in infectious diseases, particularly in emerging infectious disease, that more accurately reflects the dynamics of the transmission process. Interventions in infectious diseases can have indirect effects on those not receiving the intervention as well as direct effects on those receiving the intervention. Combinations of interventions can have complex interactions at the population level. These often cannot be adequately addressed with standard study designs and analytic methods. Simulations can help to accurately represent transmission dynamics in an increasingly complex world which is critical for proper trial design and interpretation. Some ethical aspects of a trial can also be quantified using simulations. After a trial has been conducted, simulations can be used to explore possible explanations for the observed effects. A great deal is to be gained through a multidisciplinary approach that builds collaborations among experts in infectious disease dynamics, epidemiology, statistical science, economics, simulation methods and the conduct of clinical trials.