OBJECTIVES : This study was developed to identify criteria for prioritizing treatments for Locally Advanced or Metastatic EGFR positive Non-small Cell Lung Cancer (LAM-EGFR+NSCLC) and to apply the developed framework on existing treatment alternatives, under the Brazilian private healthcare system perspective.

METHODS : A literature review was developed to identify criteria for technology prioritization in the context of interest. These were validated with representatives of patient associations, medical oncologists and private healthcare managers. Three representatives of each group were invited to participate in a MCDA panel to elicit weights for the validated criteria, using the swing weighting methodology. Treatment alternatives included in the analysis were osimertinib, afatinib, erlotinib, gefitinib, bevacizumab + erlotinib [BE] and pemetrexed + carboplatin + gefitinib [PCG]. To assess treatments’ performance in the selected criteria, data were derived from published literature and reference cost lists.

RESULTS : The criteria included in the MCDA were efficacy, safety, convenience and costs. Sub-criteria for efficacy (overall survival, progression-free survival and brain metastasis) and safety (incidence of grade 3 or higher adverse events and discontinuation due to adverse events) were also included. Efficacy was the top ranked criteria for all stakeholder groups, followed by safety, costs and convenience. The final score for the technologies varied by group. For patient representatives and medical oncologists, the top ranked alternative was osimertinib, followed by PCG and then 1^st/2^nd generation tyrosine kinase inhibitors (TKIs). For private healthcare managers, the top ranked alternatives were osimertinib and PCG, with the same final score, followed by other TKIs. BE was the last in the ranking for all stakeholders.

CONCLUSIONS : When compared to the other oral TKIs, osimertinib scored higher as a preferential treatment for LAM-EGFR+NSCLC for all stakeholder groups included in the MCDA.