Quality-adjusted survival estimation with periodic observations

Quality-adjusted survival is a measure that integrates both longevity and quality-of-life information. The analysis of quality-adjusted survival in a clinical study with data collected at periodic intervals encounters difficulties due to incomplete information. Based on observed time points, the time axis is partitioned into a set of disjoint time intervals, and under a Markovian assumption on patient's health status, the expected quality-adjusted survival is estimated as the summed product of the quality of life and its mean sojourn time of each health state within partitioned intervals. It is shown that the estimator is asymptotically normal with a simple variance calculation. A simulation study is conducted to investigate the behavior of the estimator, and a stroke study illustrates the use of the estimator.