AbstractOBJECTIVEThis review discusses how biometricians would probably compute or estimate expected waiting times, if they had the data.METHODSOur framework is a time-inhomogeneous Markov multistate model, where all transition hazards are allowed to be time-varying. We assume that the cumulative transition hazards are given. That is, they are either known, as in a simulation, determined by expert guesses, or obtained via some method of statistical estimation. Our basic tool is product integration, which transforms the transition hazards into the matrix of transition probabilities. Product integration enjoys a rich mathematical theory, which has successfully been used to study probabilistic and statistical aspects of multistate models. Our emphasis will be on practical implementation of product integration, which allows us to numerically approximate the transition probabilities. Average state occupation times and other quantities of interest may then be derived from the transition probabilities.(ProQuest: ... denotes formulae omitted.)1. IntroductionThis review is motivated by an interdisciplinary workshop on 'Multistate event history analysis' at the Netherlands Interdisciplinary Demographic Institute, The Hague, in April 2011. The workshop brought together demographers and biometricians, who both use multistate models, but appear to follow somewhat different methodological traditions.At the workshop, there were discussions on how to compute average state occupation times. The organizer, Frans Willekens, informed us that the most common approaches in demography use either piecewise linear approximations of the survival function or piece- wise constant transition hazards (personal communication). See also Gill and Keilman (1990) on these approaches, including a critique of the former method.We review how biometricians might compute expected waiting times, if they had the data. In biometry, the restriction is that right-censoring typically precludes evaluating waiting time distributions on the whole of their support. In other words, the maximum follow-up in most of the data sets analyzed by biometricians is considerably smaller than the assumed maximum age in the population under study. As a consequence, it is more common to consider median waiting times (e.g., Brookmeyer and Crowley 1982) or expectations restricted to a maximum follow-up (e.g., Andersen et al. 1993, Example IV.3.8). In the context of demography, expected (restricted) waiting times are arguably more relevant, for instance for policy making.The key idea is that a certain transformation, product integration, allows us to move from the transition hazards of a time-inhomogeneous Markov process to the matrix of transition probabilities. As also noted by Gill and Keilman (1990), combined with the initial distribution of the process, this allows us to derive expected waiting times in a given state and other quantities of interest.In demography, product integration appears to be rarely used. Gill and Keilman (1990) mention the relation, but then proceed to attack a different problem, namely estimation of constant transition hazards with population registry data. In a recent tutorial on multistate methods, Kuo, Suchindran, and Koo (2008) value product integration as a 'basic tool', but argue that it 'is difficult to implement.' These authors therefore proceed to work under special assumptions such as uniform right-censoring. Another reference is Schoen (2005) who mentions product integration as a tool for numerical evaluation, but then concentrates on special cases with an analytical solution.2. The relation between transition hazards and transition probabilitiesConsider a time-inhomogeneous Markov process (Xt)t≥0 with state space {0, 1,2, . . . ,J}. We assume that (Xt )t≥0 has right-continuous sample paths, which are constant between transition times. That is, if the process moves from state j to state k, j = k, at time t0 , Xt0 = k and Xt0 - = j . …