Estimation of treatment effects in randomised trials with non-compliance and a dichotomous outcome using structural mean models

We consider estimation of the received treatment effect on a dichotomous outcome in randomised trials with non-compliance. We explore inference about the parameters of the structural mean models of Robins (1994, 1997) and Robins et al. (1999). We show that, in contrast to the additive and multiplicative structural mean models for continuous and count outcomes, unbiased estimating functions for a nonzero (structural) treatment effect parameter do not exist in the presence of many continuous and discrete baseline covariates, even when the randomisation probabilities are known. The best that can be hoped for are estimators, such as those proposed in this paper, that are guaranteed both to estimate consistently the (null) treatment effect when the null hypothesis of no treatment effect is true and to have small bias when the true treatment effect is close to but not equal to zero. Copyright 2004, Oxford University Press.