Improving RCT-Based Treatment Effect Estimation Under Covariate Mismatch via Calibrated Alignment

Real-world evidence (RWE) studies that emulate target trials increasingly inform regulatory and clinical decisions, yet residual, hard-to-quantify biases still limit their credibility. The recently proposed BenchExCal framework addresses this challenge via a two-stage Benchmark, Expand, Calibrate process, which first compares an observational emulation against an existing randomized controlled trial (RCT), then uses observed divergence to calibrate a second emulation for a new indication causal effect estimation. While methodologically powerful, BenchExCal is resource intensive and difficult to scale. We introduce TrialCalibre, a conceptualized multiagent system designed to automate and scale the BenchExCal workflow. Our framework features specialized agents such as the Orchestrator, Protocol Design, Data Synthesis, Clinical Validation, and Quantitative Calibration Agents that coordi-nate the the overall process. TrialCalibre incorpo-rates agent learning (e.g., RLHF) and knowledge blackboards to support adaptive, auditable, and transparent causal effect estimation.

Estimating heterogeneous treatment effects (CATE) requires simultaneously detecting effect modification and quantifying estimation uncertainty. Existing tree-based methods make an uneasy trade-off: significance-based approaches (Radcliffe and Surry 2011) identify subgroup interactions directly but lack valid inference; honest causal trees (Athey and Imbens 2016) deliver nominal confidence interval coverage but use outcome-agnostic splitting criteria that sacrifice interaction sensitivity. We introduce a hybrid algorithm that fuses significance-based splitting with honest sample-splitting and cross-validation. Our splitting criterion uses the squared $t$-statistic for the treatment $\times$ side interaction ($t^2$), which is shown to be directly aligned with the honest $\text{EMSE}_τ$ criterion when the interaction is strong. Post-hoc honest cross-validation selects the cost-complexity penalty, giving a single principled estimator with nominal CI coverage at the leaf level. For forests, we retain bootstrap count vectors to enable an infinitesimal jackknife (IJ) variance estimate of Monte-Carlo convergence rather than formal pointwise inference. On the three synthetic designs from (Athey and Imbens 2016) the single tree achieves approximately 90% leaf-average CI coverage at the 90% nominal level across all three designs (200 replications each); on the Criteo, Hillstrom and Starbucks uplift datasets we match Qini coefficient performance of S-, T-learner and GRF baselines. An open-source Python package with reproducible seeds, sklearn-compatible API, and full test coverage accompanies this work (https://codeberg.org/hadjipantelis/rattus).

Estimating how much an intervention helps a given individual the conditional average treatment effect (CATE) is increasingly central to decision-making in medicine, economics, and policy, where an estimate is most useful when accompanied by a calibrated uncertainty interval. We study the few-placebo regime, in which one treatment arm is much smaller than the other, as arises in unequal-allocation trials and small-holdout $A/B$ tests. The standard estimator in this setting is the X-Learner, and a natural way to obtain credible intervals is to make its second stage Bayesian. We show that these intervals under-cover: they contain the true effect less often than their nominal level. We trace this to a structural cause the X-Learner's regression target inherits the bias of a nuisance model fitted to the small arm, so the posterior is centered away from the true effect and we find that the standard remedy, regressing an orthogonal doubly-robust score, is also unreliable here, since the regime's limited overlap leaves the estimator either highly variable or, once stabilized, biased once more. Both consequences reflect a pattern that extends beyond causal inference: a separately estimated variance is attached to a point estimate of a hard-to-learn quantity, and the point estimate's bias is not captured by that variance. We propose GP-CATE, which models each arm's outcome surface with a Gaussian process, so the scarce arm's uncertainty enters the posterior directly rather than as an unmodelled bias. Across synthetic and semi-synthetic benchmarks, GP-CATE attains calibrated coverage where the estimators we compare against including Causal Forest and BART do not, at the cost of intervals that are appropriately wide when the data are uninformative.