Overview
Health Technology Assessment (HTA) agencies around the world frequently evaluate whether real-world evidence (RWE) from one country can be used to inform healthcare decisions in another. However, differences in healthcare delivery, patient characteristics, and clinical data collection make comparing survival outcomes across borders challenging. To address this, the Flatiron FORUM research consortium conducted two demonstrative case studies to illustrate how benchmarking can be used for understanding cross-country comparability of overall survival (OS). The two studies assessed the comparability of OS in metastatic non-small cell lung cancer (US vs. France) and multiple myeloma (US vs. Germany), after cross-country data harmonization and population adjustment.
The findings reinforce that benchmarking's real value lies in generating transferable knowledge. Across tumor types and countries, benchmarking shows when covariate adjustment narrows cross-country survival gaps and when it does not, where alignment is consistently achievable, and what drives residual discrepancies — such as variations in disease coding, variable availability, and follow-up completeness. Demonstrative exercises such as these help decision-makers calibrate confidence in international RWE when local validation isn't feasible.
Why this matters
When local real-world data is limited, benchmarking provides a structured method to evaluate whether international evidence can fill clinical evidence gaps. By establishing clear feasibility checks and transparent standards for cross-country data comparison, this approach could help regulatory and HTA bodies make more confident, evidence-based decisions, ultimately accelerating patient access to new cancer therapies worldwide.