When evaluating the effectiveness of a treatment, policy, or intervention, the desired measure of effectiveness may be expensive to collect, not routinely available, or may take a long time to occur. In these cases, it is sometimes possible to identify a surrogate outcome that can more easily/quickly/cheaply capture the effect of interest. Theory and methods for evaluating the strength of surrogate markers have been well studied in the context of a single surrogate marker measured in the course of a randomized clinical study. However, methods are lacking for quantifying the utility of surrogate markers when the dimension of the surrogate grows and/or when study data are observational. We propose an efficient nonparametric method for evaluating high-dimensional surrogate markers in studies where the treatment need not be randomized. Our approach draws on a connection between quantifying the utility of a surrogate marker and the most fundamental tools of causal inference -- namely, methods for estimating the average treatment effect. We show that recently developed methods for incorporating machine learning methods into the estimation of average treatment effects can be used for evaluating surrogate markers. This allows us to derive limiting asymptotic distributions for key quantities, and we demonstrate their good performance in simulation.
The primary benefit of identifying a valid surrogate marker is the ability to use it in a future trial to test for a treatment effect with shorter follow-up time or less cost. However, previous work has demonstrated potential heterogeneity in the utility of a surrogate marker. When such heterogeneity exists, existing methods that use the surrogate to test for a treatment effect while ignoring this heterogeneity may lead to inaccurate conclusions about the treatment effect, particularly when the patient population in the new study has a different mix of characteristics than the study used to ev…
Shortcomings of randomized clinical trials are pronounced in urgent health crises, when rapid identification of effective treatments is critical. Leveraging short-term surrogates in real-world data (RWD) can guide policymakers evaluating new treatments. In this paper, we develop novel estimators for the proportion of treatment effect (PTE) on the true outcome explained by a surrogate in RWD settings. We propose inverse probability weighted and doubly robust (DR) estimators of an optimal transformation of the surrogate and PTE by semi-nonparametrically modeling the relationship between the true…
Given the long follow-up periods that are often required for treatment or intervention studies, the potential to use surrogate markers to decrease the required follow-up time is a very attractive goal. However, previous studies have shown that using inadequate markers or making inappropriate assumptions about the relationship between the primary outcome and surrogate marker can lead to inaccurate conclusions regarding the treatment effect. Currently available methods for identifying and validating surrogate markers tend to rely on restrictive model assumptions and/or focus on uncensored outcom…
Motivated by increasing pressure for decision makers to shorten the time required to evaluate the efficacy of a treatment such that treatments deemed safe and effective can be made publicly available, there has been substantial recent interest in using an earlier or easier to measure surrogate marker, $S$, in place of the primary outcome, $Y$. To validate the utility of a surrogate marker in these settings, a commonly advocated measure is the proportion of treatment effect on the primary outcome that is explained by the treatment effect on the surrogate marker (PTE). Model based and model free…
We revisit the classical causal inference problem of estimating the average treatment effect in the presence of fully observed confounding variables using two-stage semiparametric methods. In existing theoretical studies of methods such as G-computation, inverse propensity weighting (IPW), and two common doubly robust estimators -- augmented IPW (AIPW) and targeted maximum likelihood estimation (TMLE) -- they are either bias-dominated, or have similar asymptotic statistical properties. However, when applied to real datasets, they often appear to have notably different variance. We compare thes…
The advent and subsequent widespread availability of preventive vaccines has altered the course of public health over the past century. Despite this success, effective vaccines to prevent many high-burden diseases, including HIV, have been slow to develop. Vaccine development can be aided by the identification of immune response markers that serve as effective surrogates for clinically significant infection or disease endpoints. However, measuring immune response marker activity is often costly, which has motivated the usage of two-phase sampling for immune response evaluation in clinical tria…
Improving Causal Inference with Measurement Errors in Exposures and Confounders: A New Method and Its Application to Air Pollution Exposure Assessment and Epidemiology
