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arXiv · 2608.01625

Target Trial Emulation with the R Package TTE: A Tutorial and Methodological Guide

Hisashi Noma
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Abstract

Target trial emulation structures observational causal analyses around the protocol of an ideal randomized trial. By aligning eligibility, treatment assignment, time zero, and follow-up, it can reduce avoidable biases, but implementation still requires coordinated decisions about data construction, inverse probability weighting, diagnostics, outcome models, standardization, competing risks, and uncertainty estimation. This article provides a self-contained methodological guide and practical tutorial for TTE, an R package for target trial emulations with longitudinal observational data. We describe target trial protocols, intention-to-treat and per-protocol estimands, identification assumptions, baseline and person-period data structures, temporal ordering for longitudinal weights, stabilized treatment and censoring weights, weight truncation, balance and effective-sample-size diagnostics, weighted pooled discrete-time survival models, model-based standardization, competing-risk analysis, weighted Kaplan-Meier and Aalen-Johansen estimation, and cluster bootstrap at the original-individual level. Two fully synthetic examples illustrate end-to-end workflows: sodium-glucose cotransporter 2 inhibitor versus dipeptidyl peptidase-4 inhibitor initiation with all-cause death, and sequentially nested angiotensin receptor blocker versus calcium channel blocker trials with heart-failure hospitalization and competing death. The examples show how to obtain and diagnose estimates in R and interpret relative hazards, absolute risks, cumulative incidence, and differences between intention-to-treat and per-protocol effects.

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BibTeXRIS

Hisashi Noma. 2026-08-28. Target Trial Emulation with the R Package TTE: A Tutorial and Methodological Guide. https://arxiv.org/abs/2608.01625

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