Cong Jiang

The focus of precision medicine is on decision support, often in the form of dynamic treatment regimes, which are sequences of decision rules. At each decision point, the decision rules determine the next treatment according to the patient’s baseline characteristics, the information on treatments and responses accrued by that point, and the patient’s current health status, including symptom severity and other measures. However, dynamic treatment regime estimation with ordinal outcomes is rarely studied, and rarer still in the context of interference – where one patient’s treatment may affect another’s outcome. In this paper, we introduce the weighted proportional odds model: a regression based, approximate doubly-robust approach to single-stage dynamic treatment regime estimation for ordinal outcomes. This method also accounts for the possibility of interference between individuals sharing a household through the use of covariate balancing weights derived from joint propensity scores. Examining different types of balancing weights, we verify the approximate double robustness of weighted proportional odds model with our adjusted weights via simulation studies. We further extend weighted proportional odds model to multi-stage dynamic treatment regime estimation with household interference, namely dynamic weighted proportional odds model. Lastly, we demonstrate our proposed methodology in the analysis of longitudinal survey data from the Population Assessment of Tobacco and Health study, which motivates this work. Furthermore, considering interference, we provide optimal treatment strategies for households to achieve smoking cessation of the pair in the household.

Precision medicine describes health care where patient‐level data are used to inform treatment decisions. Within this framework, dynamic treatment regimes (DTRs) are sequences of decision rules that take individual patient information as input data and then output treatment recommendations. DTR estimation from observational data typically relies on the assumption of no interference: i.e., the outcome of one individual is unaffected by the treatment assignment of others. However, in many social network contexts, such as friendship or family networks, and for many health concerns, such as infectious diseases, this assumption is questionable. We investigate the DTR estimation method of dynamic weighted ordinary least squares (dWOLS), which boasts of easy implementation and the so‐called double‐robustness property, but relies on the assumption of no interference. We define a network propensity function and build on it to establish an implementation of dWOLS that remains doubly robust under interference associated with network links. The method's properties are demonstrated via simulation and applied to data from the Population Assessment of Tobacco and Health (PATH) study to investigate cigarette dependence within two‐person household networks.