Optimal Individualized Decision Rules Using Instrumental Variable Methods

There is an extensive literature on the estimation and evaluation of optimal individualized treatment rules in settings where all confounders of the effect of treatment on outcome are observed. We study the development of individualized decision rules in settings where some of these confounders may not have been measured but a valid binary instrument is available for a binary treatment. We first consider individualized treatment rules, which will naturally be most interesting in settings where it is feasible to intervene directly on treatment. We then consider a setting where intervening on treatment is infeasible, but intervening to encourage treatment is feasible. In both of these settings, we also handle the case that the treatment is a limited resource so that optimal interventions focus the available resources on those individuals who will benefit most from treatment. Given a reference rule, we evaluate an optimal individualized rule by its average causal effect relative to a prespecified reference rule. We develop methods to estimate optimal individualized rules and construct asymptotically efficient plug-in estimators of the corresponding average causal effect relative to a prespecified reference rule. for this article are available online.

Automated summary

This study discusses the development of individualized decision rules in settings where some confounders may not have been measured but a valid binary instrument is available for a binary treatment. It focuses on individualized treatment rules, especially in settings where direct intervention on treatment is feasible, and also considers a scenario where intervening on treatment is not feasible but encouraging treatment is possible. Optimal interventions prioritize individuals who will benefit most from treatment, especially when treatment is a limited resource.