The volume, granularity and heterogeneity of real-world evidence have been growing exponentially as technology and electronic platforms have provided new opportunities to access, link and integrate these data and use them for outcomes research and regulatory purposes. While clinical trial evidence remains the gold standard for causal evaluation of treatment efficacy, there is increasing interest and potential for using innovative study designs to derive comparative effectiveness when RCTS cannot be performed and for integrating evidence in decision-analytic models to estimate long-term benefits, harms, costs and other aspects as well as the related tradeoffs between these different outcomes. In the era of joint health technology assessments an important topic is which approaches and methods could be used to enable cross-border collaboration, evidence generation, data analysis and interpretation.