On two-sample McNemar test

Measuring a change in the existence of disease symptoms before and after a treatment is examined for statistical significance by means of the McNemar test. When comparing two treatments, Feuer and Kessler (1989) proposed a two-sample McNemar test. In this article, we show that this test usually inflates the type I error in the hypothesis testing, and propose a new two-sample McNemar test that is superior in terms of preserving type I error. We also make the connection between the two-sample McNemar test and the test statistic for the equal residual effects in a 2 × 2 crossover design. The limitations of the two-sample McNemar test are also discussed.