Benchmarking Counterfactual Prediction in Epidemic Time Series with Time-Varying Interventions

Most benchmarks for causal inference over time series are observational, small, or domain-specific, leaving interventional and counterfactual estimation under-served exactly where it matters most, such as in healthcare, policy evaluation, and climate science. We introduce \textbf{DoTime}, an open, scalable, and theoretically grounded generator of multivariate temporal structural causal models (TSCMs) with interventions, released as the \code{dotime} PyPI package together with four frozen evaluation suites. Beyond existing work, it adds capabilities absent from prior generators: continuous-time intervention \emph{windows}, counterfactual sampling modes with a positivity guard, regime-switching SCMs as a strict generalization of interrupted time series, non-stationary dynamics by construction with switching SCM parameters, and deterministic ramp and sinusoidal intervention profiles that place trends and structural breaks \emph{inside} the evaluation window. Moreover, it demonstrates the suitability of the generator as a prior for a causal foundation model reference implementation. The released suites span a training-scale snapshot of $100{,}000$ trajectories and eight named identification structures, each with exact ground truth: paired interventional trajectories from the same SCM throughout, and shared-noise counterfactuals in the continuous-time suite. We ship reference baseline implementations with an evaluation harness, and pose a falsifiable claim: interventional training buys a measurable direction-accuracy advantage over an observational model of identical capacity. It is tested across three training seeds per arm. Under structure-matched evaluation on held-out episodes, the interventional prior-fitted network's (PFN) gap is positive in every structure, trajectory length, and seed tested.

Decision-making with deep learning-based time series forecasting requires not only accurate predictions but also actionable insights. However, current architectures do not inherently provide such information. Specifically, guidance is needed on how current conditions must be modified to shift from a predicted outcome to a desired future scenario. Counterfactual explanations provide a natural framework for this task, as they represent minimal input changes that alter the model's prediction, indicating when and how intervention is required. Existing approaches rely on instance-wise optimization, leading to inconsistency across instances, high computational costs, and limited applicability in real-time settings. To address these limitations, we reformulate counterfactual generation for time series forecasting as the problem of learning a globally consistent intervention strategy, allowing counterfactuals to be generated through a single shared function. We propose Counterfactual Time Series Explanations (ConTex), a model-agnostic, decomposed architecture comprising a temporal context encoder and a conditional encoder, followed by two heads that capture interventions in terms of temporal relevance and modification strength. This structure overcomes the instability and inconsistency of instance-based approaches by producing targeted, interpretable interventions across time and feature dimensions in a single forward pass, making it suitable for real-time applications. Across multiple forecasting architectures and benchmark datasets, ConTex achieves state-of-the-art validity while generating sparse counterfactuals that minimize the number of necessary interventions. Additionally, our approach reduces computational cost by at least 12-36x compared to instance-wise generation and supports real-time inference at approximately 0.007 seconds.

Longitudinal treatment decisions from multivariate time-series data require predicting potential outcomes under future treatment sequences in the presence of time-varying confounding, heterogeneous patient dynamics, and limited domain-specific data. Existing longitudinal causal estimators typically address this problem by training a new model for each cohort or simulator. We introduce Causal Longitudinal Prior-Fitted Networks (CausalLongPFN), a prior-fitted network for time-series causal inference in longitudinal treatment-response data and zero-shot in-context counterfactual outcome prediction. The model is pretrained entirely on synthetic episodes sampled from a broad prior over temporal structural causal models, exposing it to treatment-confounder feedback, latent heterogeneity, nonlinear state evolution, delayed effects, and cumulative treatment responses. At test time, CausalLongPFN remains frozen and is used zero-shot: it conditions on support trajectories, a query history, and a planned future treatment sequence, and returns a predictive distribution over future outcomes without gradient updates or propensity-model fitting. Multi-step predictions are obtained by recursively applying the one-step predictor under the specified treatment sequence. We evaluate the model on branchable cancer, HIV, and warfarin benchmarks with ground-truth counterfactual labels, and on factual-only rolling-origin prediction in MIMIC-III ICU trajectories. CausalLongPFN is competitive with domain-trained longitudinal baselines on counterfactual benchmarks and performs strongly on factual MIMIC-III prediction, suggesting that broad synthetic causal pretraining can provide a frozen, amortized alternative for zero-shot longitudinal treatment-response prediction when repeated domain-specific training is costly or impractical.