Submitted:
02 August 2026
Posted:
03 August 2026
You are already at the latest version
Abstract
Keywords:
1. Introduction
1.1. The Problem
1.2. Schemes and Notation
1.3. Contributions
1.4. Related Work
2. The Recoverable-Time Kernel
2.1. The Delay Operator
2.2. Savings as a Linear Functional
3. Comparing Schemes
3.1. The Exact Decomposition
3.2. What a Single Look Cannot Escape
4. The Stopping Law
4.1. The Monitored Process
4.2. First Passage as the Primitive
4.3. General Boundaries, and the Exact Linear Case
4.4. Which Ledger Takes the Kernel
5. Type-I Error
6. The Optimal Boundary Is the SPRT Boundary
6.1. Purity and the Likelihood Ratio
6.2. The Design Problem
7. Mixtures and the Measurement of Regret
7.1. The Binary State Is a Projection
7.2. Regret Is a Joint Probability, Not a Product
8. Case Study: A Non-Oncology Phase III Trial
8.1. Setting
8.2. The Comparator
8.3. Parameters
| symbol | value | basis |
| 36 months | phase III typically 1–4 years | |
| N | 500 patients | phase III commonly 300–500 |
| cost/patient | $60,000 | published per-patient phase III costs, ≈$40k–113k [4] |
| 3.24 | power, two-sided : | |
| 0 | doomed = exact null (the least favourable case) | |
| conditional-power convention | ||
| d | 2 months | committee convening, interim lock, implementation; |
| 0.40 | phase III attrition [21]; enters purity and portfolio figures only |
8.4. Operating Characteristics
8.5. Results
| scheme | detection | averted exposure | months | patients | |
| no interim | — | — | 0 | 0 | 0 |
| , deployed convention | 185 | ||||
| best single look, matched budget | 217 | ||||
| continuous, matched budget | — |
8.6. Regret, Measured Jointly
| continuous | at | best look at | |
8.7. Sensitivity to the Operational Lag
| d (months) | convention | best look () | continuous | vs. best | vs. convention | |
| () | ||||||
| 1 | () | |||||
| 2 | () | |||||
| 3 | () | |||||
| 4 | () | |||||
| 6 | () |
8.8. Purity of the Recommended Design
8.9. Impact
8.10. What the Example Establishes
9. Discussion
9.1. What the Analysis Supports
9.2. Beyond Clinical Trials
9.3. Limitations
9.4. Extensions
10. Conclusions
Appendix A. Comparison Identities
Appendix B. First Passage for a Linear Boundary
Appendix C. Type-I Error
Appendix D. Purity and the Likelihood Ratio
Appendix E. The Design Problem
References
- Anderson, T.W. (1960). A modification of the sequential probability ratio test to reduce sample size. Annals of Mathematical Statistics, 31(1), 165–197. [CrossRef]
- Bachelier, L. (1900). Théorie de la spéculation. Annales Scientifiques de l’École Normale Supérieure, 17, 21–86. [CrossRef]
- Chernoff, H. (1961). Sequential tests for the mean of a normal distribution. Proc. Fourth Berkeley Symposium, 1, 79–91.
- DiMasi, J.A., Grabowski, H.G. and Hansen, R.W. (2016). Innovation in the pharmaceutical industry: new estimates of R&D costs. Journal of Health Economics, 47, 20–33. [CrossRef]
- Durbin, J. (1985). The first-passage density of a continuous Gaussian process to a general boundary. Journal of Applied Probability, 22(1), 99–122. [CrossRef]
- Fortet, R. (1943). Les fonctions aléatoires du type de Markoff associées à certaines équations linéaires aux dérivées partielles du type parabolique. Journal de Mathématiques Pures et Appliquées, 22, 177–243.
- Hampson, L.V. and Jennison, C. (2013). Group sequential tests for delayed responses. Journal of the Royal Statistical Society B, 75(1), 3–54.
- Jennison, C. and Turnbull, B.W. (2000). Group Sequential Methods with Applications to Clinical Trials. Chapman and Hall/CRC.
- Lan, K.K.G. and DeMets, D.L. (1983). Discrete sequential boundaries for clinical trials. Biometrika, 70(3), 659–663. [CrossRef]
- Lan, K.K.G., Simon, R. and Halperin, M. (1982). Stochastically curtailed tests in long-term clinical trials. Sequential Analysis, 1(3), 207–219. [CrossRef]
- Lan, K.K.G. and Wittes, J. (1988). The B-value: a tool for monitoring data. Biometrics, 44(2), 579–585. [CrossRef]
- Lévy, P. (1948). Processus Stochastiques et Mouvement Brownien. Gauthier-Villars, Paris.
- O’Brien, P.C. and Fleming, T.R. (1979). A multiple testing procedure for clinical trials. Biometrics, 35(3), 549–556. [CrossRef]
- Pocock, S.J. (1977). Group sequential methods in the design and analysis of clinical trials. Biometrika, 64(2), 191–199. [CrossRef]
- Proschan, M.A., Lan, K.K.G. and Wittes, J.T. (2006). Statistical Monitoring of Clinical Trials: A Unified Approach. Springer.
- Shiryaev, A.N. (1978). Optimal Stopping Rules. Springer-Verlag.
- Siegmund, D. (1985). Sequential Analysis: Tests and Confidence Intervals. Springer.
- Wald, A. (1947). Sequential Analysis. Wiley, New York.
- Wald, A. and Wolfowitz, J. (1948). Optimum character of the sequential probability ratio test. Annals of Mathematical Statistics, 19(3), 326–339. [CrossRef]
- Whitehead, J. (1997). The Design and Analysis of Sequential Clinical Trials, 2nd rev. ed. Wiley.
- Wong, C.H., Siah, K.W. and Lo, A.W. (2019). Estimation of clinical trial success rates and related parameters. Biostatistics, 20(2), 273–286. [CrossRef]

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).