Smoothed landmark estimators of the transition probabilities

One important goal in clinical applications of multi-state models is the estimation of transition probabilities. Recently, landmark estimators were proposed to estimate these quantities, and their superiority with respect to the competing estimators has been proved in situations in which the Markov condition is violated. As a weakness, it provides large standard errors in estimation in some circumstances. In this article, we propose two approaches that can be used to reduce the variability of the proposed estimator. Simulations show that the proposed estimators may be much more efficient than the unsmoothed estimator. A real data illustration is included.