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We consider two while-alive estimands for recurrent events data \[\begin{align*} \frac{E(N(D \wedge t))}{E(D \wedge t)} \end{align*}\] and the mean of the subject specific events per time-unit \[\begin{align*} E( \frac{N(D \wedge t)}{D \wedge t} ) \end{align*}\] for two treatment-groups in the case of an RCT. For the mean of events per time-unit it has been seen that when the sample size is small one can improve the finite sample properties by employing a transformation such as square or cube-root, and thus consider \[\begin{align*} E( (\frac{N(D \wedge t)}{D \wedge t})^.33 ) \end{align*}\]
data(hfactioncpx12)
dtable(hfactioncpx12,~status)
#>
#> status
#> 0 1 2
#> 617 1391 124
dd <- WA_recurrent(Event(entry,time,status)~treatment+cluster(id),hfactioncpx12,time=2,death.code=2)
summary(dd)
#> While-Alive summaries:
#>
#> RMST, E(min(D,t))
#> Estimate Std.Err 2.5% 97.5% P-value
#> treatment0 1.859 0.02108 1.817 1.900 0
#> treatment1 1.924 0.01502 1.894 1.953 0
#>
#> Estimate Std.Err 2.5% 97.5% P-value
#> [treatment0] - [treat.... -0.06517 0.02588 -0.1159 -0.01444 0.0118
#>
#> Null Hypothesis:
#> [treatment0] - [treatment1] = 0
#> mean events, E(N(min(D,t))):
#> Estimate Std.Err 2.5% 97.5% P-value
#> treatment0 1.572 0.09573 1.384 1.759 1.375e-60
#> treatment1 1.453 0.10315 1.251 1.656 4.376e-45
#>
#> Estimate Std.Err 2.5% 97.5% P-value
#> [treatment0] - [treat.... 0.1185 0.1407 -0.1574 0.3943 0.4
#>
#> Null Hypothesis:
#> [treatment0] - [treatment1] = 0
#> _______________________________________________________
#> Ratio of means E(N(min(D,t)))/E(min(D,t))
#> Estimate Std.Err 2.5% 97.5% P-value
#> treatment0 0.8457 0.05264 0.7425 0.9488 4.411e-58
#> treatment1 0.7555 0.05433 0.6490 0.8619 5.963e-44
#>
#> Estimate Std.Err 2.5% 97.5% P-value
#> [treatment0] - [treat.... 0.09022 0.07565 -0.05805 0.2385 0.233
#>
#> Null Hypothesis:
#> [treatment0] - [treatment1] = 0
#> _______________________________________________________
#> Mean of Events per time-unit E(N(min(D,t))/min(D,t))
#> Estimate Std.Err 2.5% 97.5% P-value
#> treat0 1.0725 0.1222 0.8331 1.3119 1.645e-18
#> treat1 0.7552 0.0643 0.6291 0.8812 7.508e-32
#>
#> Estimate Std.Err 2.5% 97.5% P-value
#> [treat0] - [treat1] 0.3173 0.1381 0.04675 0.5879 0.02153
#>
#> Null Hypothesis:
#> [treat0] - [treat1] = 0
dd <- WA_recurrent(Event(entry,time,status)~treatment+cluster(id),hfactioncpx12,time=2,
death.code=2,trans=.333)
summary(dd,type="log")
#> While-Alive summaries, log-scale:
#>
#> RMST, E(min(D,t))
#> Estimate Std.Err 2.5% 97.5% P-value
#> treatment0 0.6199 0.011340 0.5977 0.6421 0
#> treatment1 0.6543 0.007807 0.6390 0.6696 0
#>
#> Estimate Std.Err 2.5% 97.5% P-value
#> [treatment0] - [treat.... -0.03446 0.01377 -0.06145 -0.007478 0.01231
#>
#> Null Hypothesis:
#> [treatment0] - [treatment1] = 0
#> mean events, E(N(min(D,t))):
#> Estimate Std.Err 2.5% 97.5% P-value
#> treatment0 0.4523 0.06090 0.3329 0.5716 1.119e-13
#> treatment1 0.3739 0.07097 0.2348 0.5130 1.376e-07
#>
#> Estimate Std.Err 2.5% 97.5% P-value
#> [treatment0] - [treat.... 0.07835 0.09352 -0.1049 0.2616 0.4022
#>
#> Null Hypothesis:
#> [treatment0] - [treatment1] = 0
#> _______________________________________________________
#> Ratio of means E(N(min(D,t)))/E(min(D,t))
#> Estimate Std.Err 2.5% 97.5% P-value
#> treatment0 -0.1676 0.06224 -0.2896 -0.04563 7.081e-03
#> treatment1 -0.2804 0.07192 -0.4214 -0.13947 9.651e-05
#>
#> Estimate Std.Err 2.5% 97.5% P-value
#> [treatment0] - [treat.... 0.1128 0.09511 -0.07361 0.2992 0.2356
#>
#> Null Hypothesis:
#> [treatment0] - [treatment1] = 0
#> _______________________________________________________
#> Mean of Events per time-unit E(N(min(D,t))/min(D,t))
#> Estimate Std.Err 2.5% 97.5% P-value
#> treat0 -0.3833 0.04939 -0.4801 -0.2865 8.487e-15
#> treat1 -0.5380 0.05666 -0.6491 -0.4270 2.191e-21
#>
#> Estimate Std.Err 2.5% 97.5% P-value
#> [treat0] - [treat1] 0.1548 0.07517 0.007459 0.3021 0.03948
#>
#> Null Hypothesis:
#> [treat0] - [treat1] = 0We see that the ratio of means are not very different, but that the subject specific mean of events per time-unit shows that those on the active treatment has fewer events per time-unit on average.
The number of events can be generalized in various ways by using
other outcomes than \(N(D \wedge t)\),
for example,
\[\begin{align*}
\tilde N(D \wedge t) = \int_0^t I(D \geq s) M(s) dN(s) + \sum_j M_j
I(D \leq t,\epsilon=j) )
\end{align*}\] where \(M(s)\)
are the marks related to \(N(s)\) and
are \(M_j\) marks associated with the
different causes of the terminal event. This provides an extension of
the weighted composite outcomes measure of Mao & Lin (2022).
The marks (or here weights) can be stochastic if we are couting hosptial expenses, for example, and is vector on the data-frame. The marks for the event times (defined through the causes) will then be used.
Here weighting death with weight 2 and otherwise couting the recurrent of events as before (with weight 1)
hfactioncpx12$marks <- runif(nrow(hfactioncpx12))
##ddmg <- WA_recurrent(Event(entry,time,status)~treatment+cluster(id),hfactioncpx12,time=2,
##cause=1:2,death.code=2,marks=hfactioncpx12$marks)
##summary(ddmg)
ddm <- WA_recurrent(Event(entry,time,status)~treatment+cluster(id),hfactioncpx12,time=2,
cause=1:2,death.code=2,marks=hfactioncpx12$status)sessionInfo()
#> R version 4.5.1 (2025-06-13)
#> Platform: aarch64-apple-darwin24.5.0
#> Running under: macOS Sequoia 15.6.1
#>
#> Matrix products: default
#> BLAS: /Users/kkzh/.asdf/installs/R/4.5.1/lib/R/lib/libRblas.dylib
#> LAPACK: /Users/kkzh/.asdf/installs/R/4.5.1/lib/R/lib/libRlapack.dylib; LAPACK version 3.12.1
#>
#> locale:
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#>
#> time zone: Europe/Copenhagen
#> tzcode source: internal
#>
#> attached base packages:
#> [1] splines stats graphics grDevices utils datasets methods
#> [8] base
#>
#> other attached packages:
#> [1] prodlim_2025.04.28 timereg_2.0.7 survival_3.8-3 mets_1.3.7
#>
#> loaded via a namespace (and not attached):
#> [1] cli_3.6.5 knitr_1.50 rlang_1.1.6
#> [4] xfun_0.53 KernSmooth_2.23-26 data.table_1.17.8
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#> [13] rmarkdown_2.29 grid_4.5.1 evaluate_1.0.5
#> [16] jquerylib_0.1.4 fastmap_1.2.0 numDeriv_2016.8-1.1
#> [19] yaml_2.3.10 mvtnorm_1.3-3 lifecycle_1.0.4
#> [22] compiler_4.5.1 codetools_0.2-20 ucminf_1.2.2
#> [25] Rcpp_1.1.0 future_1.67.0 lattice_0.22-7
#> [28] digest_0.6.37 R6_2.6.1 parallelly_1.45.1
#> [31] parallel_4.5.1 Matrix_1.7-4 bslib_0.9.0
#> [34] tools_4.5.1 globals_0.18.0 cachem_1.1.0These binaries (installable software) and packages are in development.
They may not be fully stable and should be used with caution. We make no claims about them.
Health stats visible at Monitor.