Gradient Regularized V-Learning for Dynamic Treatment Regimes

Deciding how to optimally treat a patient, including how to select treatments over time among the multiple available treatments, represents one of the most important issues that need to be addressed in medicine today. A dynamic treatment regime (DTR) is a sequence of treatment rules indicating how to individualize treatments for a patient based on the previously assigned treatments and the evolving covariate history. However, DTR evaluation and learning based on offline data remain challenging problems due to the bias introduced by time-varying confounders that affect treatment assignment over time; this may lead to suboptimal treatment rules being used in practice. In this paper, we introduce Gradient Regularized V-learning (GRV), a novel method for estimating the value function of a DTR. GRV regularizes the underlying outcome and propensity score models with respect to the optimality condition in semiparametric estimation theory. On the basis of this design, we construct estimators that are efficient and stable in finite samples regime. Using multiple simulation studies and one real-world medical dataset, we demonstrate that our method is superior in DTR evaluation and learning, thereby providing improved treatment options over time for patients.