COADVISE: covariate adjustment with variable selection in randomized controlled trials

Abstract Adjusting for covariates in randomized controlled trials can enhance the credibility and efficiency of treatment effect estimation. However, handling numerous covariates and their complex (nonlinear) transformations poses a challenge. Motivated by the case study of the Best Apnea Interventions for Research (BestAIR) trial data from the National Sleep Research Resource (NSRR), where the number of covariates (p=114) is comparable to the sample size (N=196), we propose a principled covariate adjustment with variable selection (COADVISE) framework. COADVISE enables variable selection for covariates most relevant to the outcome while accommodating both linear and nonlinear adjustments. This framework ensures consistent estimates with improved efficiency over unadjusted estimators and provides robust variance estimation, even under outcome model misspecification. We demonstrate efficiency gains through theoretical analysis, extensive simulations, and a re-analysis of the BestAIR trial data to compare alternative variable selection strategies, offering cautionary recommendations. A user-friendly R package, Coadvise, is available to facilitate practical implementation.