Landmark analysis at the 25-year landmark point

This statistical primer presents the landmark analysis method, exploring its appropriate use and interpretation while recognizing its limitations. This observational method is used for comparing time-to-event outcome between groups determined during study follow-up. The goal of the landmark method is to estimate in an unbiased way the time-to-event probabilities in each group conditional on the group membership of patients at a specific time point, the landmark time. The need that led to its development, the impact of the method, and its pros and cons, along with available alternative approaches, are presented. Simulations explore its performance, using realistic parameters from a recent cardiovascular study. As long as the limitations of the method are recognized and the interpretation of its results clearly reflect their "conditional" nature, landmark analysis, 25 years from its introduction, can still be of value.