Bayesian Mediation Analysis for Individualized Treatment Rules

The value of an individualized treatment rule (ITR), defined as the expected outcome under treatment assignment according to the rule, is useful for assessing average clinical benefit but does not explain how the benefit of a rule is generated. We propose a causal mediation framework for decomposing the value contrast between a prespecified candidate ITR and a clinically meaningful reference rule into direct and indirect components. Using rule-specific nested potential outcomes, we define natural direct and indirect rule effects that quantify the extent to which the improvement in value arises through pathways operating directly on the outcome versus through a specified mediator. We give identification conditions under which these components are identified by a rule-level mediation g-formula. For estimation, we adapt Bayesian causal mediation forests to obtain posterior inference for the value contrast and its path-specific components. Our simulations demonstrate that the proposed estimator achieved near-nominal credible interval coverage with decreasing bias and root mean squared error as sample size increased in settings with varying direct and mediated contributions. We further illustrate the method using data from the TRIUMPH trial, decomposing the cognitive benefit of a lifestyle intervention rule through candidate neurovascular, cardiorespiratory, and behavioral mediators. The proposed framework complements optimal ITR learning with explanation using mediation, providing a natural approach for mechanistic evaluation of ITRs.

Representation Learning for Semiparametric Causal Mediation Analysis under No Essential Heterogeneity

We propose a two-stage estimator for structural mediation parameters that combines deep representation learning with G-estimation under the "no essential heterogeneity" (NEH) assumption. We call the method UNIT. In the first stage,TARNet estimates the heterogeneous effect of a randomized treatment on a mediator by learning a shared covariate representation across treatment arms.The resulting conditional average treatment effect (CATE) estimate provides a plug-in approximation to the heterogeneity-dependent component of the weight function entering the G-estimating equation of Zheng and Zhou (2015), which identifies the structural parameters even in the presence of unmeasured mediator-outcome confounding. We show that more accurate first-stage representation learning can yield a more informative plug-in weight and thereby improve the precision of the structural parameter estimator. In simulations with non-Gaussian covariates and nonlinear mediator effects, TARNet weights reduce the Stage-2 standard error of the mediation coefficient by a factor of $1.45$ to $1.51$ (median across replications, $n \ge 2000$) relative to the classical approach, at no cost to bias or coverage.