Inferring Comprehensive Cohort Causal Effects in the Presence of Unmeasured Confounding and Missing Outcomes

Abstract

This paper presents a methodological framework for estimating the comprehensive cohort causal effect (CCCE) in mixed-design clinical studies that combine randomized controlled trials (RCTs) and parallel observational study (OBS). Our approach is designed to evaluate robustness against unmeasured confounding in the OBS arm and to handle outcomes that are missing at random in either the RCT or OBS arm. By employing a semiparametric theory-based sensitivity analysis framework, we derive the efficient influence function for the CCCE, parameterized by sensitivity parameters. We propose a one-step bias-corrected estimator that allows for flexible modeling and establish conditions under which our CCCE estimator is $\sqrt{n}$-consistent. To illustrate our methods, we apply them to the TOIB study, which evaluates the efficacy and safety of oral versus topical ibuprofen in managing chronic knee pain among older adults. We also evaluate the performance of the proposed methodology in a realistic simulation study.