Background
. Healthcare evidence generation is shifting beyond randomized controlled trials (RCTs) to embrace real-world data (RWD). Collected from diverse routine care settings, RWD underpins real-world evidence (RWE), offering insights into patient outcomes, treatment effectiveness, and healthcare delivery. While RWE enhances generalizability and cost-effectiveness compared with RCTs, its inherent complexities such as data quality issues, missingness, confounding, and selection bias demand rigorous analytical approaches.
Methods
. This critical review synthesizes the spectrum of analytical methodologies applied to RWD, ranging from traditional statistical techniques and causal inference frameworks to machine learning and advanced methods including natural language processing (NLP), Bayesian modeling, and network analysis. Each approach is appraised in terms of strengths, limitations, and suitability for addressing the unique challenges of RWD.
Results
. Traditional statistical models provide interpretability and control for observed confounding but are limited by strong assumptions and vulnerability to unmeasured confounders. Causal inference methods, such as instrumental variables and target trial emulation, strengthen causal interpretation but require strong assumptions and specialized expertise. Machine learning approaches excel in prediction and high-dimensional data analysis but face interpretability and generalizability challenges. Advanced methods, including NLP and Bayesian models, extend analytical capacity but demand significant expertise and computational resources. Across categories, triangulation of multiple methods enhances robustness and credibility.
Conclusions
. RWE plays a critical role in drug development, post-market surveillance, comparative effectiveness research, health economics and outcomes research, and personalized medicine. Future progress hinges on emerging innovations such as federated learning, synthetic data generation, and explainable AI (XAI), alongside advances in data integration, harmonization, and reproducibility. Methodological transparency, rigorous validation, and interdisciplinary collaboration are essential to ensure that RWE delivers trustworthy, ethical, and clinically actionable insights capable of informing regulatory decisions and optimizing healthcare globally.