Journal Article

A systematic comparison of recurrent event models for application to composite endpoints

Kieser, Meinhard, Rauch, Geraldine, Ozga, Ann-Kathrin

2018

Overview

Background Many clinical trials focus on the comparison of the treatment effect between two or more groups concerning a rarely occurring event. In this situation, showing a relevant effect with an acceptable power requires the observation of a large number of patients over a long period of time. For feasibility issues, it is therefore often considered to include several event types of interest, non-fatal or fatal, and to combine them within a composite endpoint. Commonly, a composite endpoint is analyzed with standard survival analysis techniques by assessing the time to the first occurring event. This approach neglects that an individual may experience more than one event which leads to a loss of information. As an alternative, composite endpoints could be analyzed by models for recurrent events. There exists a number of such models, e.g. regression models based on count data or Cox-based models such as the approaches of Andersen and Gill, Prentice, Williams and Peterson or, Wei, Lin and Weissfeld. Although some of the methods were already compared within the literature there exists no systematic investigation for the special requirements regarding composite endpoints. Methods Within this work a simulation-based comparison of recurrent event models applied to composite endpoints is provided for different realistic clinical trial scenarios. Results We demonstrate that the Andersen-Gill model and the Prentice- Williams-Petersen models show similar results under various data scenarios whereas the Wei-Lin-Weissfeld model delivers effect estimators which can considerably deviate under commonly met data scenarios. Conclusion Based on the conducted simulation study, this paper helps to understand the pros and cons of the investigated methods in the context of composite endpoints and provides therefore recommendations for an adequate statistical analysis strategy and a meaningful interpretation of results.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Algorithms / Analysis / Clinical trials / Clinical Trials as Topic / Composite endpoints / Computer Simulation / Data analysis / Endpoint Determination - methods / Endpoint Determination - statistics & numerical data / Event history analysis / Health Sciences / Humans / Medicine / Medicine & Public Health / Models, Biological / Outcome Assessment (Health Care) - methods / Outcome Assessment (Health Care) - statistics & numerical data / Proportional Hazards Models / Recurrence / Recurrent event analysis / Reproducibility of Results / Simulation study / Statistical Theory and Methods / statistics and modelling / Statistics for Life Sciences / Survival Analysis / Technical Advance / Theory of Medicine/Bioethics