markovMSM: An R Package for Checking the Markov Condition in Multi-State Survival Data

Abstract

Multi-state models can be used to describe processes in which an individual moves through a finite number of states in continuous time. These models allow a detailed view of the evolution or recovery of the process and can be used to study the effect of a vector of explanatory variables on the transition intensities or to obtain prediction probabilities of future events after a given event history. In both cases, before using these models, we have to evaluate whether the Markov assumption is tenable. This paper introduces the markovMSM package, a software application for R, which considers tests of the Markov assumption that are applicable to general multi-state models. Three approaches using existing methodology are considered: a simple method based on including covariates depending on the history; methods based on measuring the discrepancy of the non-Markov estimators of the transition probabilities to the Markovian Aalen-Johansen estimators; and, finally, methods that were developed by considering summaries from families of log-rank statistics where individuals are grouped by the state occupied by the process at a particular time point. The main functionalities of the markovMSM package are illustrated using real data examples.