Variable selection in regression-based estimation of dynamic treatment regimes

Penalized G-estimation for effect modifier selection in a structural nested mean model for repeated outcomes

Effect modification occurs when the impact of the treatment on an outcome varies based on the levels of other covariates known as effect modifiers. Modeling these effect differences is important for etiological goals and for purposes of optimizing treatment. Structural nested mean models (SNMMs) are useful causal models for estimating the potentially heterogeneous effect of a time-varying exposure on the mean of an outcome in the presence of time-varying confounding. A data-adaptive selection approach is necessary if the effect modifiers are unknown a priori and need to be identified. Although variable selection techniques are available for estimating the conditional average treatment effects using marginal structural models or for developing optimal dynamic treatment regimens, all of these methods consider a single end-of-follow-up outcome. In the context of an SNMM for repeated outcomes, we propose a doubly robust penalized G-estimator for the causal effect of a time-varying exposure with a simultaneous selection of effect modifiers and prove the oracle property of our estimator. We conduct a simulation study for the evaluation of its performance in finite samples and verification of its double-robustness property. Our work is motivated by the study of hemodiafiltration for treating patients with end-stage renal disease at the Centre Hospitalier de l'Université de Montréal. We apply the proposed method to investigate the effect heterogeneity of dialysis facility on the repeated session-specific hemodiafiltration outcomes.

Dynamic Treatment Regimes on Dyadic Networks

Identifying interventions that are optimally tailored to each individual is of significant interest in various fields, in particular precision medicine. Dynamic treatment regimes (DTRs) employ sequences of decision rules that utilize individual patient information to recommend treatments. However, the assumption that an individual's treatment does not impact the outcomes of others, known as the no interference assumption, is often challenged in practical settings. For example, in infectious disease studies, the vaccine status of individuals in close proximity can influence the likelihood of infection. Imposing this assumption when it, in fact, does not hold, may lead to biased results and impact the validity of the resulting DTR optimization. We extend the estimation method of dynamic weighted ordinary least squares (dWOLS), a doubly robust and easily implemented approach for estimating optimal DTRs, to incorporate the presence of interference within dyads (i.e., pairs of individuals). We formalize an appropriate outcome model and describe the estimation of an optimal decision rule in the dyadic-network context. Through comprehensive simulations and analysis of the Population Assessment of Tobacco and Health (PATH) data, we demonstrate the improved performance of the proposed joint optimization strategy compared to the current state-of-the-art conditional optimization methods in estimating the optimal treatment assignments when within-dyad interference exists.

Variable selection for individualised treatment rules with discrete outcomes

An individualised treatment rule (ITR) is a decision rule that aims to improve individuals' health outcomes by recommending treatments according to subject-specific information. In observational studies, collected data may contain many variables that are irrelevant to treatment decisions. Including all variables in an ITR could yield low efficiency and a complicated treatment rule that is difficult to implement. Thus, selecting variables to improve the treatment rule is crucial. We propose a doubly robust variable selection method for ITRs, and show that it compares favourably with competing approaches. We illustrate the proposed method on data from an adaptive, web-based stress management tool.

A RELUCTANT ADDITIVE MODEL FRAMEWORK FOR INTERPRETABLE NONLINEAR INDIVIDUALIZED TREATMENT RULES

Individualized treatment rules (ITRs) for treatment recommendation is an important topic for precision medicine as not all beneficial treatments work well for all individuals. Interpretability is a desirable property of ITRs, as it helps practitioners make sense of treatment decisions, yet there is a need for ITRs to be flexible to effectively model complex biomedical data for treatment decision making. Many ITR approaches either focus on linear ITRs, which may perform poorly when true optimal ITRs are nonlinear, or black-box nonlinear ITRs, which may be hard to interpret and can be overly complex. This dilemma indicates a tension between interpretability and accuracy of treatment decisions. Here we propose an additive model-based nonlinear ITR learning method that balances interpretability and flexibility of the ITR. Our approach aims to strike this balance by allowing both linear and nonlinear terms of the covariates in the final ITR. Our approach is parsimonious in that the nonlinear term is included in the final ITR only when it substantially improves the ITR performance. To prevent overfitting, we combine crossfitting and a specialized information criterion for model selection. Through extensive simulations we show that our methods are data-adaptive to the degree of nonlinearity and can favorably balance ITR interpretability and flexibility. We further demonstrate the robust performance of our methods with an application to a cancer drug sensitive study.