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Biostatistics Advance Access originally published online on July 31, 2009
Biostatistics 2009 10(4):729-743; doi:10.1093/biostatistics/kxp027
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© 2009 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Estimating dementia-free life expectancy for Parkinson's patients using Bayesian inference and microsimulation

Ardo van den Hout* and Fiona E. Matthews

Medical Research Council Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge CB2 OSR, UK ardo.vandenhout{at}mrc-bsu.cam.ac.uk

* To whom correspondence should be addressed.

Interval-censored longitudinal data taken from a Norwegian study of individuals with Parkinson's disease are investigated with respect to the onset of dementia. Of interest are risk factors for dementia and the subdivision of total life expectancy (LE) into LE with and without dementia. To estimate LEs using extrapolation, a parametric continuous-time 3-state illness–death Markov model is presented in a Bayesian framework. The framework is well suited to allow for heterogeneity via random effects and to investigate additional computation using model parameters. In the estimation of LEs, microsimulation is used to take into account random effects. Intensities of moving between the states are allowed to change in a piecewise-constant fashion by linking them to age as a time-dependent covariate. Possible right censoring at the end of the follow-up can be incorporated. The model is applicable in many situations where individuals are followed over a long time period. In describing how a disease develops over time, the model can help to predict future need for health care.

Keywords: Dementia; Life expectancy; Microsimulation; Multistate model; Random effects; Right censoring; Survival

Received September 11, 2008; revised March 30, 2009; revised May 12, 2009; accepted for publication June 27, 2009.


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