Adaptive designs for randomized trials in public health

C. Hendricks Brown, Thomas R. Ten Have, Booil Jo, Getachew Dagne, Peter A. Wyman, Bengt Muthén, Robert D. Gibbons

Research output: Contribution to journalReview articlepeer-review

117 Scopus citations


In this article, we present a discussion of two general ways in which the traditional randomized trial can be modified or adapted in response to the data being collected.We use the term adaptive design to refer to a trial in which characteristics of the study itself, such as the proportion assigned to active intervention versus control, change during the trial in response to data being collected. The term adaptive sequence of trials refers to a decision-making process that fundamentally informs the conceptualization and conduct of each new trial with the results of previous trials. Our discussion below investigates the utility of these two types of adaptations for public health evaluations. Examples are provided to illustrate how adaptation can be used in practice. From these case studies, we discuss whether such evaluations can or should be analyzed as if they were formal randomized trials, and we discuss practical as well as ethical issues arising in the conduct of these new-generation trials.

Original languageEnglish (US)
Pages (from-to)1-25
Number of pages25
JournalAnnual review of public health
StatePublished - 2009


  • CACE modeling
  • Encouragement designs
  • Growth mixture models
  • Multilevel trials
  • Multistage trials
  • Principal stratification

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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