Management of Biliary Tract Cancer: A Modified Delphi (Consensus) Survey of UK Clinical Experts
Author(s)
Mariette Odabashian, PhD1, Michelle Louise James, PhD2, Samantha Gillard, BSc, PhD2, Morteza Jalali, MD, PhD, MBA1, Brook Chambers, BA1, Joanna Naish, BSc1, Sally Bowditch, BSc, MPH1, Javier Sabater, PharmD1, Abigail Stevenson, BSc, DPhil1.
1Jazz Pharma, London, United Kingdom, 2Petauri, Bicester, United Kingdom.
1Jazz Pharma, London, United Kingdom, 2Petauri, Bicester, United Kingdom.
OBJECTIVES: BTC (biliary tract cancer) is a rare and aggressive cancer, with poor prognosis and limited treatment options. Several aspects of the UK treatment pathway lack consensus. This research aimed to gain structured expert consensus among UK clinicians on optimal patient management, expected disease progression, and typical patient outcomes. The results will support UK health technology assessments of a new HER2-directed therapy for second-line treatment of BTC.
METHODS: 14 UK clinical experts in BTC were invited to participate in a 2-round, web-based consultation using a modified Delphi methodology. Round 1 consisted of 96 scaled, open/closed-ended statements/questions, with 33 statements in Round 2. Consensus was defined as 70% of experts in agreement with a given statement. Statements not achieving consensus in Round 1 were reformulated for Round 2. Multiple choice and written responses were analysed using descriptive statistics.
RESULTS: Round 1 and Round 2 achieved 93% (n=13) and 84% (n=11) completion, respectively. Experts agreed on a range of themes, including prognostic factors for BTC, expected overall and progression-free survival (extrapolations) with different treatments, likely treatment durations, subsequent treatments, and health-state preferences (utility/disutility values). There was 100% consensus that HER2-directed therapies have the potential to improve survival outcomes in second-line HER2+ BTC vs. the UK standard of care (chemotherapy with FOLFOX). However, there was no consensus on the precise survival benefit with HER2-directed therapies for second-line BTC. In addition, HER2-testing for BTC in NHS settings was not standardised.
CONCLUSIONS: To our knowledge, this is the first UK Delphi Survey conducted in BTC. Results showed some consensus on expected survival outcomes, but inconsistency in HER2+ testing for BTC. As a rare cancer, some uncertainty in outcomes is expected, but this ‘structured expert elicitation’ can help reassure payer decision-making to enable patient access for innovative treatments in areas of high unmet need.
METHODS: 14 UK clinical experts in BTC were invited to participate in a 2-round, web-based consultation using a modified Delphi methodology. Round 1 consisted of 96 scaled, open/closed-ended statements/questions, with 33 statements in Round 2. Consensus was defined as 70% of experts in agreement with a given statement. Statements not achieving consensus in Round 1 were reformulated for Round 2. Multiple choice and written responses were analysed using descriptive statistics.
RESULTS: Round 1 and Round 2 achieved 93% (n=13) and 84% (n=11) completion, respectively. Experts agreed on a range of themes, including prognostic factors for BTC, expected overall and progression-free survival (extrapolations) with different treatments, likely treatment durations, subsequent treatments, and health-state preferences (utility/disutility values). There was 100% consensus that HER2-directed therapies have the potential to improve survival outcomes in second-line HER2+ BTC vs. the UK standard of care (chemotherapy with FOLFOX). However, there was no consensus on the precise survival benefit with HER2-directed therapies for second-line BTC. In addition, HER2-testing for BTC in NHS settings was not standardised.
CONCLUSIONS: To our knowledge, this is the first UK Delphi Survey conducted in BTC. Results showed some consensus on expected survival outcomes, but inconsistency in HER2+ testing for BTC. As a rare cancer, some uncertainty in outcomes is expected, but this ‘structured expert elicitation’ can help reassure payer decision-making to enable patient access for innovative treatments in areas of high unmet need.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO161
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Health Technology Assessment
Topic Subcategory
Clinician Reported Outcomes
Disease
Gastrointestinal Disorders, Oncology, Rare & Orphan Diseases