A cluster randomised study is one where a group of subjects are randomised to the same treatment together—for example, when women in some districts are offered breast cancer screening and compared with women in other districts, or when the patients of general practitioners who have been given special training are compared with the patients of those who have not.1

Several techniques exist for analysing the data from such studies, but the essence of them is that the experimental unit (district or general practitioner) is the unit of analysis.2 A simple approach is to construct a summary statistic for each cluster and then analyse these summary values. The idea is similar to the analysis of repeated measurements on the same subject, where we construct a single summary …