OBJECTIVES

: To identify and designate a weight for key criteria to the public reimbursement decision-making process in the setting of adjuvant therapy for melanoma in Brazil through the Analytic Hierarchy Process (AHP) multi-criteria decision analysis (MCDA) method.

METHODS

: A literature review was carried out to form a set of criteria, considering the adjuvant melanoma treatment context. One day online panel with patients’ representatives, oncologists and payers (n=3, each) was conducted to validate the final set of criteria and to apply the AHP method to elicit weight for each selected criteria.

RESULTS

: After the panel discussion, a set with thirteen criteria and six categories was defined: overall survival [OS], distant metastasis-free survival [dMFS] and relapse-free survival [RFS] representing efficacy; adverse events with grade ≥3 [AEs], immunomediated adverse events [IAE] and tolerability representing safety; incremental cost-effectiveness ratio, annual treatment cost, cost per responder and budget impact analysis representing economic profile; productivity, quality of life and convenience representing social profile; technological profile and access operationalization. Oncologists ranked OS (weight: 21.3%) as the main criterion followed by RFS (17.5%) and AEs (17.2%). For patients, OS, dMFS and RFS were equally the main criteria (19.4%), tolerability (10.9%) and quality of life (6.7%). For payers, OS (35.4%) and AEs (24.6%) were the main criteria, followed by RFS (7.5%). For all groups, efficacy was the main category, while access operationalization was the less important category for oncologists; economic profile for patients’ representatives and technological profile for payers.

CONCLUSIONS

: According to patients, oncologists and payers, efficacy and OS were the most important category and criteria, respectively, to be evaluated before making a public reimbursement decision in melanoma adjuvant treatment. The ranking of other categories and criteria differed between each group, which indicates different priorities from each perspective that must be considered during a health technology assessment.