May be this is just too much cynicism but isn't it possible the GAO just failed to do what it was supposed to do and is offering that paragraph as a poor way to explain away their failure? The trend of it being more expensive in the US is a real, statistically determinable fact. That hints there are structural reasons for it. They should at least give a stab at it rather than throwing up their hands and claiming ther…
https://pedestrianobservations.com/2019/07/22/new-report-on-... + see the design-build vs design then build comment(s) too.