Recoverability of causal effects under presence of missing data: a longitudinal case study

Missing data in multiple variables is a common issue. We investigate the applicability of the framework of graphical models for handling missing data to a complex longitudinal pharmacological study of children with HIV treated with an efavirenz-based regimen as part of the CHAPAS-3 trial. Specifically, we examine whether the causal effects of interest, defined through static interventions on multiple continuous variables, can be recovered (estimated consistently) from the available data only. So far, no general algorithms are available to decide on recoverability, and decisions have to be made on a case-by-case basis. We emphasize the sensitivity of recoverability to even the smallest changes in the graph structure, and present recoverability results for three plausible missingness-directed acyclic graphs (m-DAGs) in the CHAPAS-3 study, informed by clinical knowledge. Furthermore, we propose the concept of a "closed missingness mechanism": if missing data are generated based on this mechanism, an available case analysis is admissible for consistent estimation of any statistical or causal estimand, even if data are missing not at random. Both simulations and theoretical considerations demonstrate how, in the assumed MNAR setting of our study, a complete or available case analysis can be superior to multiple imputation, and estimation results vary depending on the assumed missingness DAG. Our analyses demonstrate an innovative application of missingness DAGs to complex longitudinal real-world data, while highlighting the sensitivity of the results with respect to the assumed causal model.