A Decision-Theoretic Method for Analyzing Crossing Survival Curves in Healthcare

Appelbaum, Elie and Leshno, Moshe and Prisman, Eitan and Prisman, Eliezer, Z. (2025): A Decision-Theoretic Method for Analyzing Crossing Survival Curves in Healthcare.

Abstract

The problem of crossing Kaplan-Meier curves has not been solved in the medical research literature to date. This paper integrates survival curve comparisons into decision theory, providing a theoretical framework and a solution to the problem of crossing Kaplan-Meier curves. The application of decision theory allows us to apply stochastic dominance concepts and risk preference attributes to compare treatments even when standard Kaplan-Meier curves cross. The paper shows that as additional risk preference attributes are adopted, Kaplan-Meier curves can be ranked under weaker restrictions, namely with higher orders of stochastic dominance. Consequently, even Kaplan-Meier curves that cross may be ranked. The method we present allows us to extract all possible information from survival functions; hence, superior treatments that cannot be identified using standard Kaplan-Meier curves may become identifiable. Our methodology is applied to two examples of published empirical medical studies. We show that treatments deemed non-comparable because their Kaplan-Meier curves intersect can be compared using our method.

• Item Type: MPRA Paper
• Language: English
• Keywords: Survival Curve Analysis; Decision Theory; Risk Preference Modelling; Stochastic Dominance; Medical Treatment Comparison; Healthcare Data Interpretation
• Subjects: C - Mathematical and Quantitative Methods > C1 - Econometric and Statistical Methods and Methodology: General > C18 - Methodological Issues: General; C - Mathematical and Quantitative Methods > C6 - Mathematical Methods ; Programming Models ; Mathematical and Simulation Modeling > C65 - Miscellaneous Mathematical Tools; D - Microeconomics > D8 - Information, Knowledge, and Uncertainty > D81 - Criteria for Decision-Making under Risk and Uncertainty; I - Health, Education, and Welfare > I1 - Health > I10 - General; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I19 - Other

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