On the role of surrogates in the efficient estimation of treatment effects with limited outcome data

In many investigations, the primary outcome of interest is difficult or expensive to collect. Examples include long-term health effects of medical interventions, measurements requiring expensive testing or follow-up, and outcomes only measurable on small panels as in marketing. This reduces effective sample sizes for estimating the average treatment effect (ATE). However, there is often an abundance of observations on surrogate outcomes not of primary interest, such as short-term health effects or online-ad click-through. We study the role of such surrogate observations in the efficient estimation of treatment effects. To quantify their value, we derive the semiparametric efficiency bounds on ATE estimation with and without the presence of surrogates and several intermediary settings. The difference between these characterizes the efficiency gains from optimally leveraging surrogates. We study two regimes: when the number of surrogate observations is comparable to primary-outcome observations and when the former dominates the latter. We take an agnostic missing-data approach circumventing strong surrogate conditions previously assumed. To leverage surrogates' efficiency gains, we develop efficient ATE estimation and inference based on flexible machine-learning estimates of nuisance functions appearing in the influence functions we derive. We empirically demonstrate the gains by studying the long-term earnings effect of job training.