Nonparametric Regression Discontinuity Designs with Survival Outcomes

Adaptive experimentation enables efficient estimation of causal effects, but existing methods are not designed for survival data with censoring, where event times are only partially observed (e.g., overall survival in cancer trials but with dropout). In this paper, we develop a novel framework for adaptive experimentation to estimate causal effects under right censoring. For this, we derive the semiparametric efficiency bound for the average survival effect curve as a function of the treatment allocation policy and thereby obtain a closed-form efficiency-optimal allocation policy. The policy generalizes classical Neyman allocation to survival settings by prioritizing patient strata where both event and censoring dynamics induce high uncertainty. Building on this, we propose the Adaptive Survival Estimator (ASE), an adaptive framework that learns the allocation policy and estimates the average survival effect curve sequentially. Our framework has three main benefits: (i) it accommodates arbitrary machine learning models for nuisance estimation; (ii) it is guided by a closed-form efficiency-optimal allocation policy; and (iii) it admits strong theoretical guarantees, including asymptotic normality via a martingale central limit theorem. We demonstrate our framework across various numerical experiments to show consistent efficiency gains over uniform randomization and censoring-agnostic baselines.

Estimating causal effects on right-censored time-to-event outcomes is challenging under unmeasured confounding. Proximal causal inference addresses unmeasured confounding through proxy variables, but existing proximal survival methods rely largely on restrictive parametric bridge models. We introduce Proximal Survival Bridge learning (PSB), a flexible doubly robust proximal framework for censored outcomes. Building on existing proximal identification of treatment-specific survival curves, the framework yields outcome-bridge (OB), treatment-bridge (TB), and doubly robust (DR) estimators, with two flexible bridge learners: PSB-K, a kernel estimator with a low-rank time decomposition, and PSB-N, a neural estimator trained by a projected maximum-moment-restriction loss. Unlike existing flexible proximal learners for scalar outcomes, PSB directly handles censoring and survival-curve targets. On a standard SEM benchmark, a proximal semi-synthetic ACTG study, and the real-world Framingham study, PSB-K performs strongest on SEM and ACTG, whereas PSB-N is the most stable on Framingham. Additional results with modern causal survival baselines, weakened or invalid proxies, and heavier censoring assess robustness across challenging settings.

Conditional average treatment effects (CATEs) are central to treatment decision-making in personalized medicine. In competing risks settings, estimating CATEs from survival data allows for patient-specific assessments of treatment effectiveness for a specific event of interest while properly accounting for alternative event types. This distinction is essential in the presence of comorbidities, where competing causes of death may otherwise confound the therapeutic benefit. Focusing on right-censored survival times with binary treatment, we examine CATEs defined as covariate-conditional differences in the absolute risk for the event of interest at a fixed time. To this end, we study meta-learners which adapt machine learning algorithms for CATE estimation in competing risks scenarios. We systematically compare six meta-learners, combining Cox regression or random survival forests for risk modeling with elastic net regression or random forests for direct CATE modeling. To provide practical guidance on model selection, we evaluate their performance in multiple simulation settings, that differ in hazard complexity, treatment heterogeneity, treatment assignment, event type distribution and censoring. To facilitate applied use, we provide the R package, crsurvlearners, which implements all considered approaches.