Simulation study reveals unbiased estimation of quality-adjusted life-years in patient-level cohorts, highlighting improved accuracy for health technology assessments.
Key Points
To develop and evaluate a unified continuous-time framework for estimating quality-adjusted life-years (QALYs) that jointly models longitudinal health utility and overall survival data.
Constructed a continuous-time framework using joint longitudinal-survival models fitted via maximum likelihood with individual patient-level longitudinal health utility and survival data.
Evaluated the performance of the joint modelling framework against standard methods using Monte Carlo simulations under realistic data-generating mechanisms.
Joint longitudinal-survival modelling accurately recovered true quality-adjusted life-years without statistical bias across simulation scenarios.
Calculating quality-adjusted life-years directly from longitudinal health utility trajectories while omitting survival processes resulted in biased estimates under most evaluated scenarios.