Hao Dai , Yu Huang , Yuxi Liu , Xing He , Jingchuan Guo , Mattia Prosperi , Jiang Bian
{"title":"用纵向观测资料估计个体化治疗效果的变分时间解方正网络","authors":"Hao Dai , Yu Huang , Yuxi Liu , Xing He , Jingchuan Guo , Mattia Prosperi , Jiang Bian","doi":"10.1016/j.jbi.2025.104880","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>By leveraging real-world electronic health record (EHR) data, this study set out to estimate individualized treatment effects (ITE) in longitudinal observational settings to advance personalized medicine, addressing key challenges that are often observed in real-world clinical scenarios and pose statistical challenges, including hidden confounding and dynamic treatment regimens.</div></div><div><h3>Methods</h3><div>We propose the Variational Temporal Deconfounder Network (VTDNet), a novel framework designed to account for time-varying hidden confounding using a variational recurrent transformer-based autoencoder. Specifically, VTDNet comprises three critical components: a temporal Encoder-Decoder structure to capture hidden representation, a Treatment Block that captures interdependencies among multiple treatments, and a Potential Outcome Block that predicts both factual and counterfactual outcomes. We assess the effectiveness of the proposed framework using a synthetic dataset and two real-world datasets: MIMIC-III, an EHR dataset focusing on intensive care settings, and NACC, emphasizing neurodegenerative disease, collected using a standardized protocol from participants enrolled in Alzheimer’s Disease Research Center (ADRC) clinical cores.</div></div><div><h3>Results</h3><div>Experimental results on the synthetic dataset demonstrate superior accuracy under varying levels of confounding. On real-world EHR datasets, VTDNet achieves lower root mean squared error, mean absolute error, and influence function precision in the estimation of heterogeneous effects compared to existing state-of-the-art methods.</div></div><div><h3>Conclusion</h3><div>The proposed VTDNet offers a robust framework for estimating individualized treatment effects in longitudinal settings, effectively accommodating irregular time points and high-dimensional data while addressing hidden confounders through a deep generative approach. It holds significant potential to advance personalized medicine and support real-world evidence generation. Future work will aim to extend VTDNet to continuous treatment scenarios, such as dose–response analysis, to further broaden its applicability in clinical practice.</div></div>","PeriodicalId":15263,"journal":{"name":"Journal of Biomedical Informatics","volume":"169 ","pages":"Article 104880"},"PeriodicalIF":4.5000,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Variational temporal deconfounder network for individualized treatment effect estimation with longitudinal observational data\",\"authors\":\"Hao Dai , Yu Huang , Yuxi Liu , Xing He , Jingchuan Guo , Mattia Prosperi , Jiang Bian\",\"doi\":\"10.1016/j.jbi.2025.104880\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>By leveraging real-world electronic health record (EHR) data, this study set out to estimate individualized treatment effects (ITE) in longitudinal observational settings to advance personalized medicine, addressing key challenges that are often observed in real-world clinical scenarios and pose statistical challenges, including hidden confounding and dynamic treatment regimens.</div></div><div><h3>Methods</h3><div>We propose the Variational Temporal Deconfounder Network (VTDNet), a novel framework designed to account for time-varying hidden confounding using a variational recurrent transformer-based autoencoder. Specifically, VTDNet comprises three critical components: a temporal Encoder-Decoder structure to capture hidden representation, a Treatment Block that captures interdependencies among multiple treatments, and a Potential Outcome Block that predicts both factual and counterfactual outcomes. We assess the effectiveness of the proposed framework using a synthetic dataset and two real-world datasets: MIMIC-III, an EHR dataset focusing on intensive care settings, and NACC, emphasizing neurodegenerative disease, collected using a standardized protocol from participants enrolled in Alzheimer’s Disease Research Center (ADRC) clinical cores.</div></div><div><h3>Results</h3><div>Experimental results on the synthetic dataset demonstrate superior accuracy under varying levels of confounding. On real-world EHR datasets, VTDNet achieves lower root mean squared error, mean absolute error, and influence function precision in the estimation of heterogeneous effects compared to existing state-of-the-art methods.</div></div><div><h3>Conclusion</h3><div>The proposed VTDNet offers a robust framework for estimating individualized treatment effects in longitudinal settings, effectively accommodating irregular time points and high-dimensional data while addressing hidden confounders through a deep generative approach. It holds significant potential to advance personalized medicine and support real-world evidence generation. Future work will aim to extend VTDNet to continuous treatment scenarios, such as dose–response analysis, to further broaden its applicability in clinical practice.</div></div>\",\"PeriodicalId\":15263,\"journal\":{\"name\":\"Journal of Biomedical Informatics\",\"volume\":\"169 \",\"pages\":\"Article 104880\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-07-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Biomedical Informatics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1532046425001091\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"COMPUTER SCIENCE, INTERDISCIPLINARY APPLICATIONS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Biomedical Informatics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1532046425001091","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"COMPUTER SCIENCE, INTERDISCIPLINARY APPLICATIONS","Score":null,"Total":0}
Variational temporal deconfounder network for individualized treatment effect estimation with longitudinal observational data
Objective
By leveraging real-world electronic health record (EHR) data, this study set out to estimate individualized treatment effects (ITE) in longitudinal observational settings to advance personalized medicine, addressing key challenges that are often observed in real-world clinical scenarios and pose statistical challenges, including hidden confounding and dynamic treatment regimens.
Methods
We propose the Variational Temporal Deconfounder Network (VTDNet), a novel framework designed to account for time-varying hidden confounding using a variational recurrent transformer-based autoencoder. Specifically, VTDNet comprises three critical components: a temporal Encoder-Decoder structure to capture hidden representation, a Treatment Block that captures interdependencies among multiple treatments, and a Potential Outcome Block that predicts both factual and counterfactual outcomes. We assess the effectiveness of the proposed framework using a synthetic dataset and two real-world datasets: MIMIC-III, an EHR dataset focusing on intensive care settings, and NACC, emphasizing neurodegenerative disease, collected using a standardized protocol from participants enrolled in Alzheimer’s Disease Research Center (ADRC) clinical cores.
Results
Experimental results on the synthetic dataset demonstrate superior accuracy under varying levels of confounding. On real-world EHR datasets, VTDNet achieves lower root mean squared error, mean absolute error, and influence function precision in the estimation of heterogeneous effects compared to existing state-of-the-art methods.
Conclusion
The proposed VTDNet offers a robust framework for estimating individualized treatment effects in longitudinal settings, effectively accommodating irregular time points and high-dimensional data while addressing hidden confounders through a deep generative approach. It holds significant potential to advance personalized medicine and support real-world evidence generation. Future work will aim to extend VTDNet to continuous treatment scenarios, such as dose–response analysis, to further broaden its applicability in clinical practice.
期刊介绍:
The Journal of Biomedical Informatics reflects a commitment to high-quality original research papers, reviews, and commentaries in the area of biomedical informatics methodology. Although we publish articles motivated by applications in the biomedical sciences (for example, clinical medicine, health care, population health, and translational bioinformatics), the journal emphasizes reports of new methodologies and techniques that have general applicability and that form the basis for the evolving science of biomedical informatics. Articles on medical devices; evaluations of implemented systems (including clinical trials of information technologies); or papers that provide insight into a biological process, a specific disease, or treatment options would generally be more suitable for publication in other venues. Papers on applications of signal processing and image analysis are often more suitable for biomedical engineering journals or other informatics journals, although we do publish papers that emphasize the information management and knowledge representation/modeling issues that arise in the storage and use of biological signals and images. System descriptions are welcome if they illustrate and substantiate the underlying methodology that is the principal focus of the report and an effort is made to address the generalizability and/or range of application of that methodology. Note also that, given the international nature of JBI, papers that deal with specific languages other than English, or with country-specific health systems or approaches, are acceptable for JBI only if they offer generalizable lessons that are relevant to the broad JBI readership, regardless of their country, language, culture, or health system.