OBJECTIVES: MCDA allows structured consideration of the many aspects of value appraisal in healthcare. This study explored the value of lenvatinib for RR-DTC using holistic MCDA (EVIDEM framework). METHODS: The framework integrated 12 quantitative and 7 qualitative contextual criteria, each derived from fundamental ethical positions. By-criterion lenvatinib evidence matrices were designed for three countries (France, Italy, Spain) and two comparators (watch and wait, sorafenib) based on a systematic review and proprietary data. Value appraisal was performed by collecting weights (individual perspectives), scores (performance of lenvatinib) and qualitative inputs (impact of context) from three structured panel sessions designed to include patients, physicians, health economists and policy-decisionmakers, convened under the Chatham house rule.  Value contributions (WeightsXScores) for each criterion and variability across individuals, countries and weighting methods were analyzed. Data on usefulness of the process were collected. RESULTS: The greatest weights were given to criteria Comparative effectiveness together with Quality of evidence (Spain and Italy) or Disease severity (France). Across all countries and comparators, four criteria contributed most to the value of lenvatinib (Comparative effectiveness [16-22%], Disease severity [16-22%], Unmet needs [14-21%], Quality of evidence [14-20%]), with contributions varying by comparator and country. Some negative contributions were observed for criteria Comparative safety (versus watch and wait) and Comparative economic consequences