Learning Who to Treat When Treatment is Missing

In offline Reinforcement Learning, immediate rewards in logged batch data are often unobserved due to sparse or irregular record-keeping, or censored beyond certain reward values. This issue arises in practical settings, including health care and marketing. We investigate off-policy evaluation (OPE) in finite-horizon Markov decision processes when rewards are missing not at random (MNAR), which breaks ignorability and induces selection bias even after conditioning on states and actions. To address this, we formalize a reward-dependent propensity model and use future states as shadow variables to identify the full-data conditional mean reward. We further introduce a bridge function that recovers the conditional mean reward without explicitly modeling the MNAR mechanism, and estimate it via a min-max procedure to avoid double sampling. Building upon these identification results, we propose an Fitted-Q-Evaluation-style estimator that propagates the recovered rewards while allowing target policies to depend on past missingness indicators. Finally, we establish consistency and finite-sample error bounds for our OPE estimator, and show through experiments the strong performance of our method compared to existing methods on simulated and MIMIC-III Sepsis data.

We introduce missingness-MDPs (miss-MDPs), a novel subclass of partially observable Markov decision processes (POMDPs) that incorporates the theory of missing data. A miss-MDP is a POMDP whose observation function is a missingness function, specifying the probability that individual state features are missing (i.e., unobserved) at a time step. The literature distinguishes three canonical missingness types: missing (1) completely at random (MCAR), (2) at random (MAR), and (3) not at random (MNAR). Our planning problem is to compute near-optimal policies for a miss-MDP with an unknown missingness function, given a dataset of action-observation trajectories. Achieving such optimality guarantees for policies requires learning the missingness function from data, which is infeasible for general POMDPs. To overcome this challenge, we exploit the structural properties of different missingness types to derive probably approximately correct (PAC) algorithms for learning the missingness function. These algorithms yield an approximate but fully specified miss-MDP that we solve using off-the-shelf planning methods. We prove that, with high probability, the resulting policies are epsilon-optimal in the true miss-MDP. Empirical results confirm the theory and demonstrate superior performance of our approach over two model-free POMDP methods.

Conventional treatment policies map patient covariates to a single recommended intervention in order to maximize expected clinical outcomes. Although a rich body of causal inference methods has been developed to estimate such policies, point-valued recommendations can be highly sensitive to estimation uncertainty, model specification, and finite-sample variability, while typically providing little guidance about how confident one should be in the recommended action. In this work, we propose a set-valued policy learning paradigm for the multiple-treatment setting, in which policies output a set of plausible treatments rather than a single recommendation. This formulation enables intrinsic uncertainty quantification, with the size of the predicted set reflecting the degree of decision ambiguity. We extend the learning-to-defer framework to multiple treatments via a novel \textit{greatest Lower Bound} method, and introduce \textit{conformal policy learning}, which bridges the gap between unobserved ground-truth optimal treatments and estimated optimal treatment rules. Drawing on insights from the noisy-label literature, we develop a randomness-injection approach that guarantees marginal coverage without requiring assumptions on underlying black-box optimal treatment rules. Through experiments on synthetic data and a real-world application to In-Vitro Fertilization (IVF), we demonstrate that our methods produce robust and actionable policies that naturally incorporate clinical considerations while effectively balancing performance and reliability.