A Fundamental Measure of Treatment Effect Heterogeneity

We offer a non-parametric plug-in estimator for an important measure of treatment effect variability and provide minimum conditions under which the estimator is asymptotically efficient. The stratum specific treatment effect function or so-called blip function, is the average treatment effect for a randomly drawn stratum of confounders. The mean of the blip function is the average treatment effect (ATE), whereas the variance of the blip function (VTE), the main subject of this paper, measures overall clinical effect heterogeneity, perhaps providing a strong impetus to refine treatment based on the confounders. VTE is also an important measure for assessing reliability of the treatment for an individual. The CV-TMLE provides simultaneous plug-in estimates and inference for both ATE and VTE, guaranteeing asymptotic efficiency under one less condition than for TMLE. This condition is difficult to guarantee a priori, particularly when using highly adaptive machine learning that we need to employ in order to eliminate bias. Even in defiance of this condition, CV-TMLE sampling distributions maintain normality, not guaranteed for TMLE, and have a lower mean squared error than their TMLE counterparts. In addition to verifying the theoretical properties of TMLE and CV-TMLE through simulations, we point out some of the challenges in estimating VTE, which lacks double robustness and might be unavoidably biased if the true VTE is small and sample size insufficient. We will provide an application of the estimator on a data set for treatment of acute trauma patients.