Integrated Real-World Study Databases in 3 Diverse Asian Health Care Systems in Taiwan, India, and Thailand: Scoping Review

Abstract

Background The use of real-world data (RWD) warehouses for research in Asia is on the rise, but current trends remain largely unexplored. Given the varied economic and health care landscapes in different Asian countries, understanding these trends can offer valuable insights. Objective We sought to discern the contemporary landscape of linked RWD warehouses and explore their trends and patterns in 3 Asian countries with contrasting economies and health care systems: Taiwan, India, and Thailand. Methods Using a systematic scoping review methodology, we conducted an exhaustive literature search on PubMed with filters for the English language and the past 5 years. The search combined Medical Subject Heading terms and specific keywords. Studies were screened against strict eligibility criteria to identify eligible studies using RWD databases from more than one health care facility in at least 1 of the 3 target countries. Results Our search yielded 2277 studies, of which 833 (36.6%) met our criteria. Overall, single-country studies (SCS) dominated at 89.4% (n=745), with cross-country collaboration studies (CCCS) being at 10.6% (n=88). However, the country-wise breakdown showed that of all the SCS, 623 (83.6%) were from Taiwan, 81 (10.9%) from India, and 41 (5.5%) from Thailand. Among the total studies conducted in each country, India at 39.1% (n=133) and Thailand at 43.1% (n=72) had a significantly higher percentage of CCCS compared to Taiwan at 7.6% (n=51). Over a 5-year span from 2017 to 2022, India and Thailand experienced an annual increase in RWD studies by approximately 18.2% and 13.8%, respectively, while Taiwan’s contributions remained consistent. Comparative effectiveness research (CER) was predominant in Taiwan (n=410, or 65.8% of SCS) but less common in India (n=12, or 14.8% of SCS) and Thailand (n=11, or 26.8% of SCS). CER percentages in CCCS were similar across the 3 countries, ranging from 19.2% (n=10) to 29% (n=9). The type of RWD source also varied significantly across countries, with India demonstrating a high reliance on electronic medical records or electronic health records at 55.6% (n=45) of SCS and Taiwan showing an increasing trend in their use over the period. Registries were used in 26 (83.9%) CCCS and 31 (75.6%) SCS from Thailand but in <50% of SCS from Taiwan and India. Health insurance/administrative claims data were used in most of the SCS from Taiwan (n=458, 73.5%). There was a consistent predominant focus on cardiology/metabolic disorders in all studies, with a noticeable increase in oncology and infectious disease research from 2017 to 2022. Conclusions This review provides a comprehensive understanding of the evolving landscape of RWD research in Taiwan, India, and Thailand. The observed differences and trends emphasize the unique economic, clinical, and research settings in each country, advocating for tailored strategies for leveraging RWD for future health care research and decision-making. International Registered Report Identifier (IRRID) RR2-10.2196/43741

Integrated Real-World Data Warehouses Across 7 Evolving Asian Health Care Systems: Scoping Review

“…To further even out year-to-year variations, a 2-year simple moving average (SMA) was applied to enhance the clarity of the data trends. This SMA approach was consistent with our previous research methodologies [ 7 ]. Given the study’s descriptive nature, there was no a priori statistical hypothesis.…”

“…The other 4 nations—Indonesia, Pakistan, Vietnam, and the Philippines—were involved in fewer publications, with 8.9% (33/369), 8.4% (31/369), 7.3% (27/369), and 6% (22/369), respectively, and each had >50% of their studies classified as CCCSs (Table S3 in Multimedia Appendix 1 ). Given their lower overall study numbers and the predominance of CCCSs, these 4 nations were categorized as global collaborators in certain subsequent analyses ( Figure 2 [ 7 ]).…”

“…Our published protocol specified a preliminary focus on 3 countries—India, Thailand, and Taiwan—as a representative pilot to explore the diversity of health care systems and RWD use in Asia [ 8 ]. The outcomes from our initial study covering Taiwan, India, and Thailand have been previously published [ 7 ]. Relevant insights from the latter publication were incorporated into the archetyping of the nations wherever applicable.…”

“…Study categorization: CER versus descriptive study (non-CER), with CER definitions adapted from Medical Subject Headings. We expanded the criteria for CER to standardize its meaning in the context of this research as the “studies comparing interventions and strategies (including the comparison between active and nonactive interventions and strategies) to prevent, diagnose, treat, and monitor health conditions using validated methods for confounders elimination, e.g., matching, and statistical adjustments like stratification, weighting, regression, instrumental variable analysis etc” [ 7 ].…”

“…Recognizing this potential, our previous research explored integrated RWD warehouses within 3 diverse health care pilots for Taiwan, India, and Thailand [ 7 ]. Our systematic research identified strong differences in the types of RWD and their warehouses in the 3 countries.…”