Value contribution of trifluridine/tipiracil with bevacizumab for the treatment of metastatic colorectal cancer in Catalonia using a multicriteria decision analysis

Abstract

Colorectal cancer; Bevacizumab; Decision making

Cáncer colorrectal; Bevacizumab; Toma de decisiones

Càncer colorectal; Bevacizumab; Presa de decisions

Background Despite the alternatives available in metastatic colorectal cancer (mCRC), evaluating new therapies continues to be a challenge for clinicians and decision-makers. We aimed to generate a conceptual framework and establish the value criteria for evaluating treatments in mCRC and to apply this framework to assess the value of trifluridine/tipiracil (FTD/TPI) + bevacizumab (BEVA) in advanced lines of therapy for mCRC versus alternatives. Methods A multicriteria decision analysis (MCDA) was conducted according to the modified EVIDEM assessment framework and the following process: defining the decision problem, selecting and structuring the related criteria identified in a literature review, weighting criteria, measurement of performance, and scoring alternatives, to evaluate of mCRC therapies in Catalonia (Spain). An expert panel of five members with experience in cancer treatment in Catalonia was involved. A hierarchical and non-hierarchical weighting of the criteria and sub-criteria was performed. An evidence matrix of available treatments was developed, and experts assigned scores comparing FTD/TPI + BEVA versus alternatives. Results Five value criteria and 18 sub-criteria were selected to evaluate mCRC therapies. According to hierarchical method, efficacy had the highest weight, followed by safety, and lower weights for the rest: cost, guidelines/expert consensus, and epidemiology. In the efficacy dimension, overall survival (OS) had the highest weight, while severe adverse events received the highest score in terms of safety. Non-hierarchical weighting corroborated these results. Treatment with FTD/TPI + BEVA obtained a positive overall value contribution of 0.91, 0.43 points considering only comparative criteria. Comparative criteria were highly important, obtaining values contribution for efficacy, safety and cost of 0.19, 0.15 and 0.12 points, respectively. OS (0.20), progression-free survival (0.19), disease control rate (0.16) and health-related quality of life (0.16) were the most relevant sub-criteria. Conclusion Based on this MCDA, the high value contribution of FTD/TPI + BEVA suggests its substantial benefits over the most used alternatives.

The manuscript was prepared with the support of a grant from Servier España.