Individualized treatment rules (ITRs) have gained significant attention due to their wide-ranging applications in fields such as precision medicine, ridesharing, and advertising recommendations. However, when ITRs are influenced by sensitive attributes such as race, gender, or age, they can lead to outcomes where certain groups are unfairly advantaged or disadvantaged. To address this gap, we propose a flexible approach based on the optimal transport theory, which is capable of transforming any optimal ITR into a fair ITR that ensures demographic parity. Recognizing the potential loss of value under fairness constraints, we introduce an ``improved trade-off ITR," designed to balance value optimization and fairness while accommodating varying levels of fairness through parameter adjustment. To maximize the value of the improved trade-off ITR under specific fairness levels, we propose a smoothed fairness constraint for estimating the adjustable parameter. Additionally, we establish a theoretical upper bound on the value loss for the improved trade-off ITR. We demonstrate performance of the proposed method through extensive simulation studies and application to the Next 36 entrepreneurial program dataset.

An individualized treatment rule (ITR) is a decision rule that recommends treatments for patients based on their individual feature variables. In many practices, the ideal ITR for the primary outcome is also expected to cause minimal harm to other secondary outcomes. Therefore, our objective is to learn an ITR that not only maximizes the value function for the primary outcome, but also approximates the optimal rule for the secondary outcomes as closely as possible. To achieve this goal, we introduce a fusion penalty to encourage the ITRs based on different outcomes to yield similar recommendations. Two algorithms are proposed to estimate the ITR using surrogate loss functions. We prove that the agreement rate between the estimated ITR of the primary outcome and the optimal ITRs of the secondary outcomes converges to the true agreement rate faster than if the secondary outcomes are not taken into consideration. Furthermore, we derive the non-asymptotic properties of the value function and misclassification rate for the proposed method. Finally, simulation studies and a real data example are used to demonstrate the finite-sample performance of the proposed method.

A common concern when a policymaker draws causal inferences from and makes decisions based on observational data is that the measured covariates are insufficiently rich to account for all sources of confounding, i.e., the standard no confoundedness assumption fails to hold. The recently proposed proximal causal inference framework shows that proxy variables that abound in real-life scenarios can be leveraged to identify causal effects and therefore facilitate decision-making. Building upon this line of work, we propose a novel optimal individualized treatment regime based on so-called outcome and treatment confounding bridges. We then show that the value function of this new optimal treatment regime is superior to that of existing ones in the literature. Theoretical guarantees, including identification, superiority, excess value bound, and consistency of the estimated regime, are established. Furthermore, we demonstrate the proposed optimal regime via numerical experiments and a real data application.

An individualized treatment regime (ITR) is a decision rule that assigns treatments based on patients' characteristics. The value function of an ITR is the expected outcome in a counterfactual world had this ITR been implemented. Recently, there has been increasing interest in combining heterogeneous data sources, such as leveraging the complementary features of randomized controlled trial (RCT) data and a large observational study (OS). Usually, a covariate shift exists between the source and target population, rendering the source-optimal ITR unnecessarily optimal for the target population. We present an efficient and robust transfer learning framework for estimating the optimal ITR with right-censored survival data that generalizes well to the target population. The value function accommodates a broad class of functionals of survival distributions, including survival probabilities and restrictive mean survival times (RMSTs). We propose a doubly robust estimator of the value function, and the optimal ITR is learned by maximizing the value function within a pre-specified class of ITRs. We establish the $N^{-1/3}$ rate of convergence for the estimated parameter indexing the optimal ITR, and show that the proposed optimal value estimator is consistent and asymptotically normal even with flexible machine learning methods for nuisance parameter estimation. We evaluate the empirical performance of the proposed method by simulation studies and a real data application of sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (ICU), combining a RCT and an observational study with heterogeneity.

Evidence from observational studies has become increasingly important for supporting healthcare policy making via cost-effectiveness (CE) analyses. Similar as in comparative effectiveness studies, health economic evaluations that consider subject-level heterogeneity produce individualized treatment rules (ITRs) that are often more cost-effective than one-size-fits-all treatment. Thus, it is of great interest to develop statistical tools for learning such a cost-effective ITR (CE-ITR) under the causal inference framework that allows proper handling of potential confounding and can be applied to both trials and observational studies. In this paper, we use the concept of net-monetary-benefit (NMB) to assess the trade-off between health benefits and related costs. We estimate CE-ITR as a function of patients' characteristics that, when implemented, optimizes the allocation of limited healthcare resources by maximizing health gains while minimizing treatment-related costs. We employ the conditional random forest approach and identify the optimal CE-ITR using NMB-based classification algorithms, where two partitioned estimators are proposed for the subject-specific weights to effectively incorporate information from censored individuals. We conduct simulation studies to evaluate the performance of our proposals. We apply our top-performing algorithm to the NIH-funded Systolic Blood Pressure Intervention Trial (SPRINT) to illustrate the CE gains of assigning customized intensive blood pressure therapy.

Data-driven individualized decision making has recently received increasing research interests. Most existing methods rely on the assumption of no unmeasured confounding, which unfortunately cannot be ensured in practice especially in observational studies. Motivated by the recent proposed proximal causal inference, we develop several proximal learning approaches to estimating optimal individualized treatment regimes (ITRs) in the presence of unmeasured confounding. In particular, we establish several identification results for different classes of ITRs, exhibiting the trade-off between the risk of making untestable assumptions and the value function improvement in decision making. Based on these results, we propose several classification-based approaches to finding a variety of restricted in-class optimal ITRs and develop their theoretical properties. The appealing numerical performance of our proposed methods is demonstrated via an extensive simulation study and one real data application.