Models for predicting the time of a future event are crucial for risk assessment, across a diverse range of applications. Existing time-to-event (survival) models have focused primarily on preserving pairwise ordering of estimated event times, or relative risk. Model calibration is relatively under explored, despite its critical importance in time-to-event applications. We present a survival function estimator for probabilistic predictions in time-to-event models, based on a neural network model for draws from the distribution of event times, without explicit assumptions on the form of the distribution. This is done like in adversarial learning, but we achieve learning without a discriminator or adversarial objective. The proposed estimator can be used in practice as a means of estimating and comparing conditional survival distributions, while accounting for the predictive uncertainty of probabilistic models. Extensive experiments show that the proposed model outperforms existing approaches, trained both with and without adversarial learning, in terms of both calibration and concentration of time-to-event distributions.
Personalized probabilistic forecasts of time to event (such as mortality) can be crucial in decision making, especially in the clinical setting. Inspired by ideas from the meteorology literature, we approach this problem through the paradigm of maximizing sharpness of prediction distributions, subject to calibration. In regression problems, it has been shown that optimizing the continuous ranked probability score (CRPS) instead of maximum likelihood leads to sharper prediction distributions while maintaining calibration. We introduce the Survival-CRPS, a generalization of the CRPS to the time to event setting, and present right-censored and interval-censored variants. To holistically evaluate the quality of predicted distributions over time to event, we present the Survival-AUPRC evaluation metric, an analog to area under the precision-recall curve. We apply these ideas by building a recurrent neural network for mortality prediction, using an Electronic Health Record dataset covering millions of patients. We demonstrate significant benefits in models trained by the Survival-CRPS objective instead of maximum likelihood.