Robust Estimation and Inference with Selective Borrowing in Hybrid Controlled Trials: A Tutorial with SelectiveIntegrative and intFRT

Hybrid controlled trials (HCTs) augment randomized controlled trials (RCTs) with external controls (ECs) to improve statistical efficiency when RCTs face limited sample sizes, slow accrual, or ethical constraints.

However, valid use of ECs requires careful adjustment for covariate shift and outcome drift, as inappropriate borrowing may introduce bias and compromise inference.

This tutorial provides a practical workflow for estimation and inference in HCTs.

We first present a statistical analysis roadmap covering estimands, identification assumptions, eligibility alignment, matching, full and selective borrowing strategies, and both asymptotic inference and randomization tests.

We then demonstrate step-by-step implementation using the SelectiveIntegrative and intFRT packages.

The workflow is illustrated using a synthetic lung cancer dataset included in the intFRT package that mimics the CALGB 9633 trial and ECs from the National Cancer Database.

The tutorial aims to help applied statisticians conduct transparent, interpretable, and reproducible HCT analyses that improve efficiency while maintaining valid inference.