The win ratio: Impact of censoring and follow-up time and use with nonproportional hazards

Pharm Stat. 2020 May;19(3):168-177. doi: 10.1002/pst.1977. Epub 2019 Oct 31.

Abstract

The win ratio has been studied methodologically and applied in data analysis and in designing clinical trials. Researchers have pointed out that the results depend on follow-up time and censoring time, which are sometimes used interchangeably. In this article, we distinguish between follow-up time and censoring time, show theoretically the impact of censoring on the win ratio, and illustrate the impact of follow-up time. We then point out that, if the treatment has long-term benefit from a more important but less frequent endpoint (eg, death), the win ratio can show that benefit by following patients longer, avoiding masking by more frequent but less important outcomes, which occurs in conventional time-to-first-event analyses. For the situation of nonproportional hazards, we demonstrate that the win ratio can be a good alternative to methods such as landmark survival rate, restricted mean survival time, and weighted log-rank tests.

Keywords: hazard ratio; landmark survival rate; log-rank test; prioritized pairwise comparisons; restricted mean survival time.

MeSH terms

  • Clinical Trials as Topic / statistics & numerical data*
  • Data Interpretation, Statistical
  • Endpoint Determination / statistics & numerical data*
  • Humans
  • Models, Statistical*
  • Research Design / statistics & numerical data*
  • Survival Analysis
  • Time Factors
  • Treatment Outcome