Enhancing the Win Ratio Method for Composite Endpoints: The Win Ratio with Multiple Thresholds (WR-MT)

Music City Center 

Composite endpoints combining terminal (e.g., death) and non-terminal (e.g., hospitalization) events are widely used in cardiovascular clinical trials. The Win Ratio (WR) method, introduced by Pocock et al. (2012), prioritizes fatal events in a strict hierarchical manner, which may reduce power when treatment effects are primarily on non-fatal outcomes. We introduce the Win Ratio with Multiple Thresholds (WR-MT), which relaxes this strict prioritization by incorporating additional stages with non-zero thresholds. Our weighted adaptive approach selects these thresholds dynamically, maintaining the desirable statistical properties of the standard WR while improving the capacity to detect effects on non-fatal outcomes. Through simulations accounting for follow-up time, event associations, and treatment effect levels, as well as an application to the Digitalis Investigation Group trial, we demonstrate WR-MT's overall more favorable performance. This enhancement provides an additional statistical tool for analyzing composite endpoints in clinical trials.

Win ratio

Win statistics


Composite endpoints

Pairwise comparison

Clinical trials