Testing similarity of competing risks models by comparing transition probabilities

Abstract

Assessing whether patient populations exhibit comparable event dynamics is important for evaluating treatment equivalence, pooling cohorts and comparing clinical pathways. Existing similarity tests for competing risks models measure distances between transition intensities, which describe instantaneous event rates. In biomedical applications, similarity may be more naturally formulated through transition probabilities, which quantify cumulative event risks over a clinically relevant horizon. Assuming constant cause-specific transition intensities, we develop a framework for testing similarity based on a maximum-type distance between vectors of transition-probability functions. We propose a constrained parametric bootstrap test and establish asymptotic level control and consistency under administrative and independent exponential random right censoring. The constant-intensity formulation is motivated by small-data settings in which few events are observed and nonparametric estimators may be unstable. Simulations across sample sizes, censoring mechanisms and degrees of dissimilarity show that the proposed test can attain larger finite-sample rejection probabilities than an intensity-based benchmark under comparable alternatives. An application to routine prostate cancer data illustrates how the procedure identifies the smallest examined margin for which similarity of 90-day readmission-probability functions can be established under the fitted model. The method provides an interpretable and practically implementable basis for similarity assessment in parametric competing risks models.