Past exam of the mathematics course of the University of Cambridge / 2017 / iii / Paper 207 / 3 / c

For a treated patient the recovery transition intensity is ${\mu }_T=0.25\times 2=0.5$ per year. A symptoms spell is a holding time with an exponential distribution of rate ${\mu }_T$, soThe treatment multiplier for onset affects how often symptoms begin, not the duration of a spell once the patient is in state 2, under this homogeneous continuous-time Markov chain.

The untreated rates are ${\lambda }_U=0.2$ and ${\mu }_U=0.25$; treatment changes them to ${\lambda }_T=0.2\times 0.8=0.16$ and ${\mu }_T=0.25\times 2=0.5$. Their stationary distributions give symptoms fractionsConsequentlyThus the estimated long-run symptoms fraction under treatment is about 54.5% of the untreated fraction. This combines less frequent onset with faster recovery; it is not either individual hazard ratio alone.

Use one joint hypothesis test for $H_0:{\beta }_{\lambda }={\beta }_{\mu }=0$. Fit the unrestricted model with statistical parameters $({\lambda }_0,{\mu }_0,{\beta }_{\lambda },{\beta }_{\mu })$, where ${\lambda }_i={\lambda }_0{e}^{{\beta }_{\lambda }{z}_i}$ and ${\mu }_i={\mu }_0{e}^{{\beta }_{\mu }{z}_i}$ for treatment indicator $z_i$. Refit under $H_0$, estimating the two common baseline intensities; do not fix them at their unrestricted estimates. The likelihood-ratio test statistic isUnder regular identifiable positive-rate models, sufficient independent patient trajectories, and the null hypothesis, Wilks theorem gives two degrees of freedom because two coefficients are constrained. Reject if $D$ exceeds the chosen upper chi-squared distribution quantile. Alternatively a two-dimensional Wald test uses ${\hat{\beta }}^T\widehat{\mathrm{Cov}}(\hat{\beta }{)}^{-1}\hat{\beta }$, including the off-diagonal covariance. Two separate tests do not provide this single calibrated assessment. The point estimates alone cannot produce a numerical p-value without fitted likelihoods or a coefficient covariance matrix.