Double Variable Importance Matching to Estimate Distinct Causal Effects on Event Probability and Timing

📅 2026-02-04
📈 Citations: 0
Influential: 0
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🤖 AI Summary
This study addresses the challenge of disentangling the distinct causal effects of a treatment on both the probability of being cured and the timing of events in survival data with a cured fraction. The authors propose a novel matching-based framework that leverages a mixture cure model to inform a high-dimensional weighted distance metric, incorporating variable importance to construct separate, tailored matching strategies for estimating each causal effect. This approach is the first to enable decoupled estimation of these two types of causal effects, supported by theoretical guarantees regarding estimator consistency and optimality of the distance metric. Empirical evaluations on both simulated and real-world clinical datasets demonstrate that the framework yields robust and interpretable estimates of heterogeneous causal effects.

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📝 Abstract
In many clinical contexts, estimating effects of treatment in time-to-event data is complicated not only by confounding, censoring, and heterogeneity, but also by the presence of a cured subpopulation in which the event of interest never occurs. In such settings, treatment may have distinct effects on (1) the probability of being cured and (2) the event timing among non-cured individuals. Standard survival analysis and causal inference methods typically do not separate cured from non-cured individuals, obscuring distinct treatment mechanisms on cure probability and event timing. To address these challenges, we propose a matching-based framework that constructs distinct match groups to estimate heterogeneous treatment effects (HTE) on cure probability and event timing, respectively. We use mixture cure models to identify feature importance for both estimands, which in turn informs weighted distance metrics for matching in high-dimensional spaces. Within matched groups, Kaplan-Meier estimators provide estimates of cure probability and expected time to event, from which individual-level treatment effects are derived. We provide theoretical guarantees for estimator consistency and distance metric optimality under an equal-scale constraint. We further decompose estimation error into contributions from censoring, model fitting, and irreducible noise. Simulations and real-world data analyses demonstrate that our approach delivers interpretable and robust HTE estimates in time-to-event settings.
Problem

Research questions and friction points this paper is trying to address.

cure model
heterogeneous treatment effects
time-to-event data
causal inference
survival analysis
Innovation

Methods, ideas, or system contributions that make the work stand out.

mixture cure model
heterogeneous treatment effects
matching
time-to-event analysis
variable importance
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Yuqi Li
Department of Biostatistics & Bioinformatics, Duke University
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Quinn Lanners
Department of Biostatistics & Bioinformatics, Duke University
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Matthew M. Engelhard
Assistant Professor of Biostatistics & Bioinformatics, Duke University
machine learninghealthcaremental healthdigital health