Risk‐Based Decision Making: Estimands for Sequential Prediction Under Interventions

Biometrical Journal, vol. 66, pp. e70011

Abstract

Prediction models are used among others to inform medical decisions on interventions. Typically, individuals with high risks of adverse outcomes are advised to undergo an intervention while those at low risk are advised to refrain from it. Standard prediction models do not always provide risks that are relevant to inform such decisions: for example, an individual may be estimated to be at low risk because similar individuals in the past received an intervention which lowered their risk. Therefore, prediction models supporting decisions should target risks belonging to defined intervention strategies. Previous works on prediction under interventions assumed that the prediction model was used only at one time point to make an intervention decision. In clinical practice, intervention decisions are rarely made only once: they might be repeated, deferred, and reevaluated. This requires estimated risks under interventions that can be reconsidered at several potential decision moments. In the current work, we highlight key considerations for formulating estimands in sequential prediction under interventions that can inform such intervention decisions. We illustrate these considerations by giving examples of estimands for a case study about choosing between vaginal delivery and cesarean section for women giving birth. Our formalization of prediction tasks in a sequential, causal, and estimand context provides guidance for future studies to ensure that the right question is answered and appropriate causal estimation approaches are chosen to develop sequential prediction models that can inform intervention decisions.

Authors 17

1. Kim Luijken

   University Medical Center Utrecht

   Affiliation as printed

   Department of Epidemiology Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands

2. Paweł Morzywołek

   University of Washington · Ghent University

   Affiliation as printed

   Department of Applied Mathematics Computer Science and Statistics Ghent University Ghent Belgium

   Department of Statistics University of Washington Seattle Washington USA

3. Wouter van Amsterdam

   University Medical Center Utrecht

   Affiliation as printed

   Department of Epidemiology Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands

4. Giovanni Cinà

   Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Medical Informatics Amsterdam University Medical Centers Amsterdam the Netherlands

   Institute for Logic Language and Computation University of Amsterdam Amsterdam the Netherlands

   Pacmed Amsterdam the Netherlands

5. Jeroen Hoogland

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Epidemiology and Data Science Amsterdam University Medical Centers Amsterdam the Netherlands

6. Ruth H. Keogh

   London School of Hygiene & Tropical Medicine

   Affiliation as printed

   Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK

7. Jesse H. Krijthe

   Delft University of Technology

   Affiliation as printed

   Pattern Recognition and Bio‐Informatics Group EEMCS Delft University of Technology Delft the Netherlands

8. Sara Magliacane

   University of Amsterdam

   Affiliation as printed

   Amsterdam Machine Learning Lab University of Amsterdam Amsterdam the Netherlands

9. Thijs van Ommen

   Utrecht University

   Affiliation as printed

   Department of Information and Computing Sciences Utrecht University Utrecht the Netherlands

10. Niels B. Peek

    Manchester Academic Health Science Centre · University of Manchester

    Affiliation as printed

    Division of Informatics Imaging and Data Science Faculty of Biology, Medicine and Health University of Manchester, Manchester Academic Health Science Centre Manchester UK

11. Hein Putter Aachen Department of Biomedical Data Sciences Leiden University Medical Center Leiden The Netherlands

    Leiden University Medical Center

    Affiliation as printed

    Department of Biomedical Data Sciences Leiden University Medical Center Leiden the Netherlands

12. Maarten van Smeden

    University Medical Center Utrecht

    Affiliation as printed

    Department of Epidemiology Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands

13. Matthew Sperrin

    Manchester Academic Health Science Centre · University of Manchester

    Affiliation as printed

    Division of Informatics Imaging and Data Science Faculty of Biology, Medicine and Health University of Manchester, Manchester Academic Health Science Centre Manchester UK

14. Junfeng Wang

    Utrecht University

    Affiliation as printed

    Division of Pharmacoepidemiology and Clinical Pharmacology Department of Pharmaceutical Sciences Utrecht University Utrecht the Netherlands

15. Daniala L. Weir

    Utrecht University

    Affiliation as printed

    Division of Pharmacoepidemiology and Clinical Pharmacology Department of Pharmaceutical Sciences Utrecht University Utrecht the Netherlands

16. Vanessa Didelez

    University of Bremen · Leibniz Institute for Prevention Research and Epidemiology - BIPS

    Affiliation as printed

    Department of Biometry and Data Management Leibniz Institute for Prevention Research and Epidemiology ‐ BIPS Bremen Germany

    Faculty of Mathematics/Computer Science University of Bremen Bremen Germany

17. Nan van Geloven corresponding Aachen Department of Biomedical Data Sciences Leiden University Medical Center Leiden The Netherlands

    Leiden University Medical Center

    Affiliation as printed

    Department of Biomedical Data Sciences Leiden University Medical Center Leiden the Netherlands