Enhancing modified treatment policy effect estimation with weighted energy distance

The effects of continuous treatments are often characterized through the average dose response function, which is challenging to estimate from observational data due to confounding and positivity violations. Modified treatment policies (MTPs) are an alternative approach that aim to assess the effect of a modification to observed treatment values and work under relaxed assumptions. Estimators for MTPs generally focus on estimating the conditional density of treatment given covariates and using it to construct weights. However, weighting using conditional density models has well-documented challenges. Further, MTPs with larger treatment modifications have stronger confounding and no tools exist to help choose an appropriate modification magnitude. This paper investigates the role of weights for MTPs showing that to control confounding, weights should balance the weighted data to an unobserved hypothetical target population, that can be characterized with observed data. Leveraging this insight, we present a versatile set of tools to enhance estimation for MTPs. We introduce a distance that measures imbalance of covariate distributions under the MTP and use it to develop new weighting methods and tools to aid in the estimation of MTPs. We illustrate our methods through an example studying the effect of mechanical power of ventilation on in-hospital mortality.