Estimating the causal effects of medical treatments is difficult when clinically important outcomes are costly to measure or require long follow-up. Short-term or inexpensive surrogate outcomes offer a potential alternative, but surrogate biomarkers may be unavailable or difficult to identify. Advances in artificial intelligence (AI) have enabled increasingly accurate prediction of clinical outcomes from inexpensive, high-dimensional measurements, which creates an opportunity to use AI predictions themselves as surrogates. To this end, we develop a framework for estimating treatment effects from paired measurements obtained before and after treatment for each treated individual. A pretrained AI model is applied to the before and after measurements, and our estimator compares the resulting outcome predictions. We characterize the technical assumptions under which this within-person contrast identifies the average treatment effect on the treated, even when clinical outcomes are never observed for treated individuals. When these assumptions cannot be justified, we use prediction-powered inference to correct bias using a small number of observed clinical outcomes and obtain valid inference. Synthetic and real-world cardio-oncology experiments demonstrate the validity and accuracy of the approach.
We establish a formal connection between the decades-old surrogate outcome model in biostatistics and economics and the emerging field of prediction-powered inference (PPI). The connection treats predictions from pre-trained models, prevalent in the age of AI, as cost-effective surrogates for expensive outcomes. Building on the surrogate outcomes literature, we develop recalibrated prediction-powered inference, a more efficient approach to statistical inference than existing PPI proposals. Our method departs from the existing proposals by using flexible machine learning techniques to learn the optimal ``imputed loss'' through a step we call recalibration. Importantly, the method always improves upon the estimator that relies solely on the data with available true outcomes, even when the optimal imputed loss is estimated imperfectly, and it achieves the smallest asymptotic variance among PPI estimators if the estimate is consistent. Computationally, our optimization objective is convex whenever the loss function that defines the target parameter is convex. We further analyze the benefits of recalibration, both theoretically and numerically, in several common scenarios where machine learning predictions systematically deviate from the outcome of interest. We demonstrate significant gains in effective sample size over existing PPI proposals via three applications leveraging state-of-the-art machine learning/AI models.
Surrogate endpoints are used in place of long-term outcomes in randomized experiments when observing the real outcome for a large enough cohort is prohibitively expensive or impractical. A short-term surrogate is good if the result of an experiment using the surrogate is predictive of the result of a hypothetical study using the real outcome. Much attention has been paid to formalizing this property in causal terms, but most criteria are unidentifiable and cannot be turned into practical algorithms for learning surrogate endpoints from data. To address this, we study plug-in composite surrogates, functions of post-treatment variables that may be substituted directly for the primary outcome in a randomized experiment. We propose two methods for learning plug-in surrogates that maximize effect predictiveness, and characterize the possibility of finding endpoints that yield unbiased effect estimates in representative scenarios. Finally, in both synthetic experiments with known effects and in data from a real-world experiment, we find that our method, based on directly modeling the surrogate effect, returns plug-in endpoints more predictive of the primary effect than established methods.
Alessandro-Umberto Margueritte, Ahmet Zahid Balcıoğlu, Jesse Krijthe +2
Modern predictive systems encode beliefs that can act as useful prior information for statistical inference in data-limited settings. Using them for prior construction introduces a tradeoff: an informative prior built from a predictive model can sharpen inference from limited data, but also risks propagating error from the model into the posterior. We propose a framework for AI-informed prior elicitation that mitigates this tension by rectifying the AI-induced law that generates synthetic data before using it to inform a prior. The rectified law can be embedded into synthetic data-driven prior elicitation techniques, including as a base measure in a Dirichlet process (DP) prior on the data-generating process. We refer to the resulting prior and corresponding posterior as the rectified AI prior and rectified AI posterior. We establish Gaussian asymptotics for the rectified AI posterior under non-vanishing prior strength and derive a first-order expression for its centering bias. Our rectified AI priors substantially reduce bias compared to standard approaches, improve the coverage of credible intervals, and make AI-powered prior information more reliable. We additionally apply the rectified AI prior to a real skin disease classification task and show that it can meaningfully boost predictive performance.