Efficient Estimation of Causal Effects Under Two-Phase Sampling with Error-Prone Outcome and Treatment Measurements

Abstract

Measurement error is a common challenge for causal inference studies using electronic health record (EHR) data, where clinical outcomes and treatments are frequently mismeasured. Researchers often address measurement error by conducting manual chart reviews to validate measurements in a subset of the full EHR data -- a form of two-phase sampling. To improve efficiency, phase-two samples are often collected in a biased manner dependent on the patients' initial, error-prone measurements. In this work, motivated by our aim of performing causal inference with error-prone outcome and treatment measurements under two-phase sampling, we develop solutions applicable to both this specific problem and the broader problem of causal inference with two-phase samples. For our specific measurement error problem, we construct two asymptotically equivalent doubly-robust estimators of the average treatment effect and demonstrate how these estimators arise from two previously disconnected approaches to constructing efficient estimators in general two-phase sampling settings. We document various sources of instability affecting estimators from each approach and propose modifications that can considerably improve finite sample performance in any two-phase sampling context. We demonstrate the utility of our proposed methods through simulation studies and an illustrative example assessing effects of antiretroviral therapy on occurrence of AIDS-defining events in patients with HIV from the Vanderbilt Comprehensive Care Clinic.