Counterfactual Survival Q Learning for Longitudinal Randomized Trials via Buckley James Boosting

We propose a Buckley James (BJ) Boost Q learning framework for estimating optimal dynamic treatment regimes under right censored survival data, tailored for longitudinal randomized clinical trial settings. The method integrates accelerated failure time models with iterative boosting techniques, including componentwise least squares and regression trees, within a counterfactual Q learning framework. By directly modeling conditional survival time, BJ Boost Q learning avoids the restrictive proportional hazards assumption and enables unbiased estimation of stage specific Q functions. Grounded in potential outcomes, this framework ensures identifiability of the optimal treatment regime under standard causal assumptions. Compared to Cox based Q learning, which relies on hazard modeling and may suffer from bias under misspecification, our approach provides robust and flexible estimation. Simulation studies and analysis of the ACTG175 HIV trial demonstrate that BJ Boost Q learning yields higher accuracy in treatment decision making, especially in multistage settings where bias can accumulate.