Real-World Evidence Collaborative
Randomized controlled trials (RCTs) are traditionally used by the US Food and Drug Administration (FDA) to evaluate a product’s safety and effectiveness. While they are the gold-standard from a research perspective, RCTs are resource-intensive and require investing significant financial, time, and human capital. Coupled with unmet clinical needs and drug-access challenges, the demands of RCTs have fueled a call to action from patients and legislators. The regulatory system needs new ways to optimize the drug development process, so the delivery of effective drugs to the marketplace accelerates—while public safety remains ensured.
A large amount of patient information is captured at the point of care. Health care stakeholders are enthusiastic to explore whether that information can inform and hasten new drug development. Called real-world data (RWD), analyzing this burgeoning data source has the potential to provide real-world evidence (RWE). In turn, that RWE can tell us about the use of drugs, drug outcomes, and it can help us understand whether drugs are performing as intended in routine care.
The 21st Century Cures Act and the sixth Prescription Drug User Fee Act (PDUFA VI) set milestones for FDA to explore the use of RWE in regulatory decision-making. To inform FDA as it works to meet these milestones, the Duke-Margolis Center for Health Policy RWE Collaborative engages stakeholders to guide high-priority efforts aimed at improving the development and use of RWE. The Collaborative also strives to drive progress in the use of real-world data and evidence to improve patient treatment options and outcomes more broadly. Guided by an advisory group consisting of leaders representing medical product developers, payers, research groups, providers, patient networks, and regulators, the RWE Collaborative is interested in the following 2022 priorities:
Regulatory Acceptability of Real-World Data and Real-World Evidence...New methods of collecting data and evaluating evidence necessitates new rules for the road. This workstream looks at where regulatory policy is and where it needs to go in order to make RWD and RWE work for all stakeholders.
Learning Health Care Systems: RWD for Evidence-based Decision-making and Shared Learning...the Agency for Healthcare Research and Quality defines "learning health system" as "a health system in which internal data and experience are systematically integrated with external evidence, and that knowledge is put into practice." This workstream is interested in the current state of play for LHS implementation in the United States and how RWD/E is being leveraged to advance learning health systems.
Master RWE Protocols...Traditionally, master protocols have helped clinical trials achieve greater efficiency. This workstream asks how we can bring those lessons learned to studies that use real-world data.
Real-World Efficacy: Patient Subgroups...One of the greatest advantages of RWD is that it creates evidence about groups that are traditionally excluded from clinical trials. This workstream looks at cases where real-world data and real-world evidence can advance knowledge for the benefit of specific groups of patients.
The Real-World Evidence Collaborative is led by Research Director, Rachele Hendricks-Sturrup, DHSc, MSc, MA. To learn more about the group's efforts, please contact her at rachele.hendricks.sturrup@duke.edu
Our Team Members
Duke-Margolis has a robust team dedicated to advancing the RWE Collaborative's goals. Team members are based both in our Washington, DC office as well as in Durham, North Carolina.

Adam Aten, MPH, MSc
Assistant Research Director

Matt D'Ambrosio
Policy Research Assistant

Nora Emmott
Senior Policy Analyst

Rachele Hendricks-Sturrup, DHSc, MSc, MA
Research Director
Senior Team Member

Trevan Locke, PhD
Assistant Research Director

Maryam Nafie
Policy Research Assistant

Sandra Yankah, Ph.D.
Postdoctoral Researcher
Our work
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Brief: FDA User Fee Reauthorization and the Value of Real-World Evidence
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Brief: Cures 2.0: Building a Modern Health Data Infrastructure
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Event: The State of Real-World Evidence Policy
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Comment Letters
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Newsletters
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White Paper Citations Tracker

A Framework for Regulatory Use of Real-World Evidence
In our first white paper, we define real-world data and real-world evidence and provide context to its role in regulatory decision-making. Consider this a foundation upon which subsequent white papers are built.
Published on September 13, 2017

Characterizing RWD Quality and Relevancy for Regulatory Purposes
Not all RWD is created equal. Regulators need access to ample, well-sourced, fit-for-purpose data, and the data quality paper explains what that means.
Published on October 1, 2018

Determining Real-World Data’s Fitness for Use and the Role of Reliability
By focusing on electronic health records and patient generated health data, the data reliability paper describes a framework for how researchers and reviewers can systematically evaluate whether RWD are fit for use in regulatory decision-making.
Published on September 26, 2019

Understanding the Need for Non-Interventional Studies Using Secondary Data to Generate Real-World Evidence for Regulatory Decision Making, and Demonstrating Their Credibility
Non-interventional studies using secondary data can better reflect broader patient populations, care
settings, and drug uses found in routine clinical practice. However, questions remain as to when these types of studies are applicable. This paper about credibility and observational methods explores several of those questions.
Published on November 25, 2019

Adding Real-World Evidence to a Totality of Evidence Approach for Evaluating Marketed Product Effectiveness
In the totality of evidence paper, we explore the feasibility of overcoming the challenges faced by conducting interventional studies in the real world. How do we address ethical, operational resource barriers? What must be considered when demonstrating the credibility of a non-interventional study using secondary data?
Published on December 19, 2019

Point-of-Care Clinical Trials: Integrating Research and Care Delivery
In our Point-of-Care (POC) paper, we set a baseline for what defines and constitutes a point-of-care trial and explore the current impediments to implementing these burgeoning research methods.
Published on May 11, 2022

Aligning Shared Evidentiary Needs Among Payers and Regulators for a Real-World Data Ecosystem
The Shared Evidentiary Opportunities (SEO) paper uses disease use cases to explore building a robust real-world data ecosystem. This white paper pools the expertise of both the RWE Collaborative and the Center's Value for Medical Products Consortium.
Published on July 20, 2022
Advisory Group
Marc Berger |
Elise Berliner |
Barbara E Bierer |
Mac Bonafede |
Brian Bradbury |
Jeff Brown |
Adrian Cassidy |
Stella Chang |
Bill Crown |
Riad Dirani |
Nancy Dreyer |
Andrew Emmett |
Omar Escontrias |
John Graham |
Scott H Kollins |
Joe Henk |
Ceri Hirst |
Stacy M Holdsworth |
Solomon Iyasu |
Ryan Kilpatrick |
Carol Koro |
Lisa LaVange |
Christina Mack |
Nirosha Mahendraratnam Lederer |
Sally Okun |
Bray Patrick-Lake |
Eleanor Perfetto |
Richard Platt |
Jeremy Rassen |
Subhara Raveedran |
Stephanie Reisinger |
Khaled Sarsour |
Debra Schaumberg |
Thomas Seck |
Lauren Silvis |
Michael Taylor |
David Thompson |
Richard Willke |
Marcus Wilson |
Bob Zambon |
Observers
Jacqueline Corrigan-Curay, Principal Deputy Center Director, CDER, U.S. Food and Drug Administration
Carolyn Shore, Senior Program Officer, National Academies of Sciences, Engineering, and Medicine
- Please note that the above list is current as of September 2022 -
Funding
This project is made possible through the generosity of the Margolis Family Foundation, which provides core resources for the Center, as well as a combination of financial and in-kind contributions from collaborative members including AbbVie; Amgen; Bayer; Boehringer Ingelheim; Eli Lilly and Company; Genentech, a member of the Roche Group; GlaxoSmithKline; Janssen; Merck and Company; Novartis; Pfizer; and Teva Pharmaceuticals.
Participation of private or non-profit organizations in Center activities does not imply an endorsement by Duke University or associated entities. As part of Duke University, Duke-Margolis honors the tradition of academic independence on the part of its faculty and scholars. Neither Duke nor the Margolis Center take partisan positions, but the individual members are free to speak their minds and express their opinions regarding important issues. Duke Margolis adheres to all institutional policies on research independence and conflict of interest.