PONE-D-21-15771

Propensity score methods for comparative-effectiveness analysis: a case study of direct oral anticoagulants in the atrial fibrillation population

PLOS ONE

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Comments to the Author

Reviewer #1: The present paper is brilliant and of high qualitative level

Some issues.

In the abstract it should be added how the models performed best, that is which outcomes were evaluated to assess performance of the model.

Methods: why patients in "dabigatran only" were assessed? and not rivaroxaban etc?

Methods: I woudl remore propensity score to mimic rct, which is correct but not formally true

methods dealing with missing value shoud be added

Reviewer #2: The paper is well written and deals with the use of the best methodological approach to estimate the effectiveness of anticoagulation treatment by using a dataset extracted from the Scottish Morbidity Records (SMR). The aim of the authors was to explore the use of Propensity Score (PS) mathcing, Inverse Probability Weighting (IPW) and covariate adjustment with PS. As a clinician, I have appreciated the efforts of the authors to give a clear view on the best statistical analysis to an important topic with crucial influence on Health Technology Assessment (HTA). The Authors have clarified the main differences among the statistical approaches, for example indicating the IPW the best performing method to assess covariate balance when applied to subjects of relatively large sample-size (such as combined DOACs versus warfarin). Instead, covariate adjustment with PS appears to the most appropriate method when applied to subjects of relatively small sample-size (such as dabigatran versus warfarin).

Just one comment on the concept of the introduction of dabigatran in clinical practice. The use of dabigatran as opposed to warfarin is more linked to the more convenient management of the drug than to other reasons. This is what has happened in the recents years in the clinical practice, but the same also is seen for apixaban and rivaroxaban.

Propensity score methods for comparative-effectiveness analysis: a case study of direct oral anticoagulants in the atrial fibrillation population

PONE-D-21-15771R1

Dear Dr. Ciminata,

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Kind regards,

Carmine Pizzi

Academic Editor

PLOS ONE