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 by conducting benchmarking studies that compare health outcomes across countries using real-world data. Using data from the US-based Flatiron Health database comprised of >320K patients with lung cancer and the French ESME database, this study aimed to compare patient characteristics and first-line treatment patterns in mNSCLC. Researchers found over half of French patients received platinum-based chemotherapy regardless of histology, while US patients more frequently received immunotherapy or targeted therapy.
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 new treatments come to the US market months or years earlier than other countries. This research highlights the challenges of applying RWE across different healthcare settings, and these findings are crucial for guiding population adjustment in transportability analyses of real-world outcomes between countries. 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.