CASCADE Conformal Prediction: Uncertainty-Adaptive Prediction Intervals for Two-Stage Clinical Decision Support
Authors: Ricardo Diaz-Rincon, Muxuan Liang, Adolfo Ramirez-Zamora, Benjamin Shickel
Organizations: University of Florida · 2MD Anderson Cancer Center · University of Louisville.
Abstract
Effective medication management in Parkinson's Disease (PD) is challenging due to heterogeneous disease progression, variable patient response, and medication side effects. While AI models can forecast levodopa equivalent daily dose (LEDD) as a measure of medication needs, standard uncertainty quantification often fails to communicate the reliability of these predictions, treating high and low confidence clinical decisions identically. We introduce CASCADE (Calibrated Adaptive Scaling via Conformal And Distributional Estimation), a novel conformal prediction framework that propagates epistemic uncertainty from a screening classifier to adapt downstream predictions. Unlike standard conformal methods that rely on auxiliary residual regression, we leverage epistemic uncertainty from a primary classification task (identifying whether a medication change is needed) to dynamically scale the prediction intervals of a secondary regression task (predicting how much change). By mapping Venn-Abers multi-probabilistic uncertainty directly to non-conformity scores, our framework achieves continuous risk adaptation. We demonstrate that this ``cascade effect'' produces highly efficient intervals for confident patients (38.9% narrower than standard conformal baselines) while automatically expanding intervals to ensure robust coverage for uncertain cases, bridging the gap between discrete clinical decision-making and continuous dose forecasting in PD.
Conformal prediction (CP) is a widely used frequentist framework to quantify uncertainty by constructing prediction sets with user-specified marginal coverage guarantees. In practice, CP is typically applied on top of probabilistic classifiers, which are able to express aleatoric but not epistemic uncertainty. In this paper, we consider the question of how to optimally employ CP on top of a more expressive formalism, namely credal sets, which can express both aleatoric and epistemic uncertainty. More specifically, we propose probabilistic Bernoulli prediction sets (BPS) and derive a variant that achieves conditional coverage for valid credal sets while remaining minimal in expected size. We then address the more realistic scenario in which the validity of the credal sets is not guaranteed. Assuming access to calibration data with ground-truth distributions over labels, we apply conformal risk control to BPS and derive a PAC-style guarantee: with high probability over the data, the achieved conditional coverage is at least the desired level. We validate our theoretical findings empirically over various datasets.
Alireza Javanmardi, Soroush H. Zargarbashi, Santo M. A. R. Thies +3
We present Distribution-aware Conformal Prediction (DCP), a unified framework integrating probabilistic predictors like Monte Carlo dropout, deep ensembles, and quantile regression with score-agnostic conformal calibration to produce valid and efficient prediction intervals. Leveraging a numerical inversion approach to construct interval bounds, DCP accommodates arbitrary combinations of distribution generating predictors and nonconformity scores. Benchmark analysis on synthetic and real-world time series data demonstrate DCP's ability to adaptively calibrate prediction intervals under varying uncertainty regimes. Crucially, DCP's modular design facilitates plug-and-play experimentation with different predictor-score pairings, quantitatively supported by a newly introduced modified Winkler score that balances validity and efficiency by explicitly penalizing undercoverage. While DCP generalizes and extends existing approaches like Conformalized Quantile Regression and Conformalized Monte Carlo, its modular design allows further extensions, setting a foundation for advancing uncertainty quantification in dynamic environments and high-risk applications.
Conformal Prediction (CP) provides robust uncertainty guarantees for predictive models, but is typically applied post hoc, which misaligns model training with the conformal goal of producing efficient (i.e., narrow) intervals. We propose SPACR (Single-Pass Adaptive Conformal Regressor), a novel method for directly training uncertainty-aware regressors within a differentiable loss. SPACR jointly optimizes accuracy, efficiency, and validity without batch-splitting or a predefined confidence level during training. As a result, a single SPACR model yields valid prediction intervals at multiple confidence levels during inference, avoiding the costly retraining required by methods like Directly Optimized Inductive Conformal Regression (DOICR). Experiments on diverse tabular and image datasets show that SPACR consistently gives tighter intervals and better coverage-efficiency trade-offs compared to standard CP and DOICR, while significantly reducing computational costs relative to retraining-dependent baselines.