The sequential test of two treatments when subjects are paired in many-to-one ratio

A class of sequential binomial tests and a sequential rank test can be applied for testing two treatments when subjects are paired in many-to-one ratio. The efficiency of each test is examined in terms of the average sample number. The binomial tests are much easier and more convenient to apply than the rank test not as efficient. Within the class of binomial test, the median test appears to be the most efficient is general.