Hi everyone,

I constructed a multi-state model with 4 different stages based on the book by Melinda Mills and the mstate package manual (for R) by Putter et all. Somebody suggested adding a frailty factor, since this would fit the data better. When constructing my multi-state model, I followed the steps as decribed in both the book and the manual, but nothing was written about adding a fraitly factor when it came to multistate models.

My questions are:

- What are the considerations for adding a frailty factor to a multi-state model?

- How should this be done? Is there a package in R that can do this for me or should I add something to my current analysis using the mstate package

- How do you decide beween an additive frailty model, a nested frailty model or a joint frailty model?

I don't have a background in math or statistics, so I would really appreciate it if somebody could help me out.

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