Accounting for Model Uncertainty in Survival Analysis Improves Predictive Performance

Abstract

Survival analysis is concerned with finding models to predict the survival of patients or to assess the efficacy of a clinical treatment. A key part of the model-building process is the selection of the predictor variables. It is standard to use a stepwise procedure guided by a series of significance tests to select a single model, and then to make inference conditionally on the selected model. However, this ignores model uncertainty, which can be substantial. We review the standard Bayesian model averaging solution to this problem and extend it to survival analysis, introducing partial Bayes factors to do so for the Cox proportional hazards model. In two examples, taking account of model uncertainty enhances predictive performance, to an extent that could be clinically useful. 1 Introduction From 1974 to 1984 the Mayo Clinic conducted a double-blinded randomized clinical trial involving 312 patients to compare the drug DPCA with a placebo in the treatment of primary biliary cirrhosis..