Adaptive Semi-supervised Inference for Optimal Treatment Decisions with Electronic Medical Record Data

A treatment regime is a rule that assigns a treatment to patients based on their covariate information. Recently, estimation of the optimal treatment regime that yields the greatest overall expected clinical outcome of interest has attracted a lot of attention. In this work, we consider estimation of the optimal treatment regime with electronic medical record data under a semi-supervised setting. Here, data consist of two parts: a set of ‘labeled’ patients for whom we have the covariate, treatment and outcome information, and a much larger set of ‘unlabeled’ patients for whom we only have the covariate information. We proposes an imputation-based semi-supervised method, utilizing ‘unlabeled’ individuals to obtain a more efficient estimator of the optimal treatment regime. The asymptotic properties of the proposed estimators and their associated inference procedure are provided. Simulation studies are conducted to assess the empirical performance of the proposed method and to compare with a fully supervised method using only the labeled data. An application to an electronic medical record data set on the treatment of hypotensive episodes during intensive care unit (ICU) stays is also given for further illustration.