A scoping review of causal methods enabling predictions under hypothetical interventions

TL;DR

This review identifies and analyzes methods that incorporate causal inference into prediction models to estimate outcomes under hypothetical interventions, highlighting two main approaches and current validation challenges.

Contribution

It systematically reviews existing causal methods for predictive modeling under hypothetical interventions, clarifying their assumptions, approaches, and unresolved validation issues.

Findings

Most methods are based on marginal structural models and g-estimation.

Two main approaches: enriching models with causal effects and estimating directly from observational data.

Validation techniques for causal prediction models are still developing.

Abstract

Background and Aims: The methods with which prediction models are usually developed mean that neither the parameters nor the predictions should be interpreted causally. However, when prediction models are used to support decision making, there is often a need for predicting outcomes under hypothetical interventions. We aimed to identify published methods for developing and validating prediction models that enable risk estimation of outcomes under hypothetical interventions, utilizing causal inference: their main methodological approaches, underlying assumptions, targeted estimands, and potential pitfalls and challenges with using the method, and unresolved methodological challenges. Methods: We systematically reviewed literature published by December 2019, considering papers in the health domain that used causal considerations to enable prediction models to be used for predictions under hypothetical interventions. Results: We identified 4919 papers through database searches and a further 115 papers through manual searches, of which 13 were selected for inclusion, from both the statistical and the machine learning literature. Most of the identified methods for causal inference from observational data were based on marginal structural models and g-estimation. Conclusions: There exist two broad methodological approaches for allowing prediction under hypothetical intervention into clinical prediction models: 1) enriching prediction models derived from observational studies with estimated causal effects from clinical trials and meta-analyses; and 2) estimating prediction models and causal effects directly from observational data. These methods require extending to dynamic treatment regimes, and consideration of multiple interventions to operationalise a clinical decision support system. Techniques for validating 'causal prediction models' are still in their infancy.