ADJUSTING FOR TREATMENT SWITCHING IN RCTS – IDENTIFYING, ANALYSING AND JUSTIFYING APPROPRIATE METHODS- A CASE STUDY IN METASTATIC MELANOMA

Author(s)

Bell H1, Latimer N1, Amonkar M2, Swann S2
1University of Sheffield, Sheffield, UK, 2Novartis Pharmaceuticals Corporation, Wayne, PA, USA

OBJECTIVES: Participants in oncology randomised controlled trials (RCT) are often permitted to switch from their randomised treatments onto alternative treatments. Intention-to-treat (ITT) assessments are prone to bias in the presence of switching and consequently the overall survival (OS) benefit and cost-effectiveness of the novel treatment may be underestimated. Regardless, decision-makers frequently reject statistical analyses which adjust for treatment switching in health technology assessment, often due to poor justification of methodological assumptions. This study applies adjustment methods to an RCT comparing dabrafenib to dacarbazine in patients with BRAF V600E/K mutation-positive metastatic melanoma, and investigates which adjustment method best fits this specific case study.  METHODS: The adjustment methods applied included the Rank Preserving Structural Failure Time Model (RPSFTM), Inverse Probability of Censoring Weights (IPCW), and two-stage adjustment. The suitability of each method was assessed by investigating their assumptions and trial characteristics. RESULTS: CONCLUSIONS: Adjusting for switching showed an increased OS effect for dabrafenib. Methodological assumptions must be rigorously investigated to demonstrate whether and which adjustment methods are justified.

Conference/Value in Health Info

2015-11, ISPOR Europe 2015, Milan, Italy

Value in Health, Vol. 18, No. 7 (November 2015)

Code

RM1

Topic

Clinical Outcomes, Methodological & Statistical Research, Study Approaches

Topic Subcategory

Clinical Outcomes Assessment, Confounding, Selection Bias Correction, Causal Inference, Modeling and simulation

Disease

Oncology

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