Efficiency of naive estimators for accelerated failure time models under length‐biased sampling

In prevalent cohort studies where subjects are recruited at a cross‐section, the time to an event may be subject to length‐biased sampling, with the observed data being either the forward recurrence time, or the backward recurrence time, or their sum. In the regression setting, assuming a semiparametric accelerated failure time model for the underlying event time, where the intercept parameter is absorbed into the nuisance parameter, it has been shown that the model remains invariant under these observed data setups and can be fitted using standard methodology for accelerated failure time model estimation, ignoring the length bias. However, the efficiency of these estimators is unclear, owing to the fact that the observed covariate distribution, which is also length biased, may contain information about the regression parameter in the accelerated life model. We demonstrate that if the true covariate distribution is completely unspecified, then the naive estimator based on the conditional likelihood given the covariates is fully efficient for the slope.