Presentation (CTI)

OBJECTIVES: Benchmarking compares predicted measures against reference measures and can support health technology assessment (HTA), particularly when assessing whether international real-world survival data might supplement or contextualize limited local evidence. Such assessments are complicated by cross-country differences in patient characteristics, treatments, healthcare system features, and data-capture processes. Clarifying when survival estimates generated in one country are relevant to another is therefore an important consideration for HTA.
METHODS: The Flatiron FORUM, a consortium of researchers and industry partners, conducted two exploratory case studies comparing overall survival (OS) estimates between the United States (US) and ex-US countries using datasets for metastatic non-small cell lung cancer (France) and multiple myeloma (Germany). Each analysis assessed dataset feasibility, harmonized available variables, and compared study and target samples to confirm the data were fit-for-use and sufficiently comparable. Only when these assessments indicated suitability did the analysis proceed to compare OS estimates after standardizing the study sample to resemble the target sample.
RESULTS: The two case studies highlighted that differences in variables availability, harmonization, cohort composition, disease-coding practices, and follow-up completeness can influence the feasibility and interpretation of OS comparisons. In some settings, standardized and observed OS estimates showed areas of alignment after accounting for observable characteristics. In others, discrepancies could reflect differences in measurement, cohort structure, or data capture. These examples illustrate how benchmarking may help indicate where international RWD could provide useful context and where caution may be warranted due to limitations in data availability, population alignment, or the structure of the underlying healthcare system.
CONCLUSIONS: Benchmarking can highlight the potential relevance of international RWD in HTA. Experience from the Flatiron FORUM suggests that transparent assumptions, feasibility evaluation, and improved data standards may support more informative cross-country OS comparisons and guide appropriate use of international survival evidence in decision making.