I think it’s worth some discussion about the criteria that an analytical method should meet in this setting. Then we can discuss particular models. Here’s a draft:
- The statistical method must be able to distinguish a more severe outcome from a less severe outcome, with the result being that a treatment that has more benefit on more severe outcomes getting credit for this.
- It should have a reasonable way to “score” early less severe events against later more severe events.
- Multiple occurrences of the same event should be considered as worse than single occurrences.
- Ideally, it should allow for competing risks by accounting for irrelevant absorbing states, e.g., non-related cause of death.
The last point is tricky. A method that allows for a hierarchy of severity of events may not accommodate a cause of death such as “accidental” that interrupts the follow-up and masks other relevant events. Methods that explicitly handle competing risks don’t currently allow for multiple types of events of differing severity, and perhaps not for recurring nonfatal events.