Determining the Value Contribution of Trifluridine/Tipiracil With Bevacizumab for the Treatment of Metastatic Colorectal Cancer in Catalonia Using a Multi-Criteria Decision Analysis

OBJECTIVES: To apply a multi-criteria decision analysis (MCDA) to assess the value of trifluridine/tipiracil (FTD/TPI) + bevacizumab (BEVA) in advanced lines of therapy for metastatic colorectal cancer (mCRC) compared to the available therapeutic alternatives.

METHODS: An MCDA was conducted to evaluate of mCRC therapies in Catalonia (Spain) following the modified EVIDEM framework. An expert committee (EC) of five regional experts with broad experience in oncology and decision-making in Catalonia was involved. After the literature review and first meeting, five value criteria and 18 sub-criteria were selected to evaluate mCRC most used alternatives in Catalonia. The EC carried out a hierarchical and non-hierarchical weighting of the (sub-)criteria. An evidence matrix was developed including information about available treatments and EC assigned scores comparing FTD/TPI+BEVA versus alternatives. The mean scores for each (sub-)criterion were estimated and normalized to obtain the value contribution (ranging from −1 to 1) for FTD/TPI+BEVA versus alternatives.

RESULTS: FTD/TPI+BEVA obtained a positive overall value contribution of 0.91 points compared to alternatives. To reach this value, comparative (sub-)criteria were highly important, obtaining values contribution for efficacy, safety and cost of 0.19, 0.15 and 0.12 points, respectively, compared to alternatives. Analyzing efficacy in depth, the most relevant sub-criteria were overall survival (0.20), progression-free survival (0.19), disease control rate (0.16) and health-related quality of life (0.16) based on weighting attribution. The safety domain also achieved positive scores in all the sub-criteria analyzed (range of 0.13-0.17 points). In terms of costs, although the pharmacological cost received the lowest, albeit positive, score (0.05), non-pharmacological medical treatment-related costs (0.12) and indirect costs (0.13) received a higher score.

CONCLUSIONS: Based on this MCDA, the high value contribution of FTD/TPI+BEVA suggests its substantial benefits over the most used alternatives. The scores it reached are close to the maximum possible value, indicating the importance of the disease treated and the treatment benefits.