Overview
Health technology assessment (HTA) agencies around the world increasingly rely on real-world evidence (RWE) to understand how cancer treatments perform in everyday clinical practice. Many HTA bodies prefer data collected locally or regionally because healthcare delivery systems, patient populations, and treatment practices often differ between countries. However, this preference creates a challenge when local data are limited or unavailable–raising an important question: can RWE from one country be reliably used to inform decisions in another?
The Flatiron FORUM (Fostering Oncology RWE Uses and Methods) research consortium is addressing this gap through a series of benchmarking studies that compare health outcomes across countries using real-world data. In this study, data from the US-based Flatiron Health Research Database and the Austrian AGMT registry were used to assess whether survival outcomes were transportable between the US and Austria. Despite similarities in median age and tumor subtype distribution, a model consistently underestimated overall survival for Austrian patients. Similar findings were observed across multiple tumor subtypes, suggesting underlying differences in patient populations or healthcare systems.
Why this matters
As cancer care becomes more global and data-driven, the ability to use RWE from different countries could help fill evidence gaps and support faster, more informed HTA decisions—especially when local data are lacking. This research highlights the challenges of applying RWE across different healthcare settings, as evidenced by the significant differences in survival outcomes between the US and Austrian datasets. Continuing to expand this research will improve understanding of when and how evidence is transportable in oncology, and whether there are circumstances in which underlying differences in healthcare systems necessitate the use of local data.