## Evaluating Survival Models

The most frequently used evaluation metric of survival models is the concordance index (c index, c statistic). It is a measure of rank correlation between predicted risk scores $\hat{f}$ and observed time points $y$ that is closely related to Kendall’s τ. It is defined as the ratio of correctly ordered (concordant) pairs to comparable pairs. Two samples $i$ and $j$ are comparable if the sample with lower observed time $y$ experienced an event, i.e., if $y_j > y_i$ and $\delta_i = 1$, where $\delta_i$ is a binary event indicator. A comparable pair $(i, j)$ is concordant if the estimated risk $\hat{f}$ by a survival model is higher for subjects with lower survival time, i.e., $\hat{f}_i >\hat{f}_j \land y_j > y_i$, otherwise the pair is discordant. Harrell's estimator of the c index is implemented in concordance_index_censored.

While Harrell's concordance index is easy to interpret and compute, it has some shortcomings:

- it has been shown that it is too optimistic with increasing amount of censoring [1],
- it is not a useful measure of performance if a specific time range is of primary interest (e.g. predicting death within 2 years).

Since version 0.8, scikit-survival supports an alternative estimator of the concordance index from right-censored survival data, implemented in concordance_index_ipcw, that addresses the first issue.

The second point can be addressed by extending the well known receiver operating characteristic curve (ROC curve) to possibly censored survival times. Given a time point $t$, we can estimate how well a predictive model can distinguishing subjects who will experience an event by time $t$ (sensitivity) from those who will not (specificity). The function cumulative_dynamic_auc implements an estimator of the cumulative/dynamic area under the ROC for a given list of time points.

The first part of this post will illustrate the first issue with simulated survival data, while the second part will focus on the time-dependent area under the ROC applied to data from a real study.