PCN403 IDENTIFYING KEY CRITERIA FOR HEALTH TECHNOLOGY ASSESSMENT FOR ADJUVANT TREATMENT OF EARLY BREAST CANCER IN BRAZIL: A MCDA APPROACH

Abstract

To identify key criteria and their relevance to the health technology assessment (HTA) process for adjuvant therapies in early breast cancer (EBC) in Brazil. Face-to-face meeting with oncologists, patients’ representants, public payers and HTA experts (n=3 each). A literature review was carried out in search of criteria within EBC. DEMATEL method was applied for the weighting process and to classify each criterion as cause or effect. Final set included 11 criteria within seven categories: invasive-disease–free survival (iDFS), disease-free survival (DFS) and overall survival (OS) (efficacy); adverse events and cardiac safety (safety); cost-effectiveness ratio and budget impact analysis (BIA) (economic); recurrence risk assessment (RRA), health-related quality of life (HRQoL), productivity and convenience. For oncologists, the main criterion was RRA (weight: 11.06%), classified as cause, followed by iDFS (11.01%) and OS (10.99%). The least important was cost-effectiveness (4.67%; effect). Patients classified HRQoL as the main criterion (16,39%; cause), followed by RRA (12.56%). For them, all of efficacy and safety criteria were classified as cause. Payers weighted BIA (12.18%) and cost-effectiveness (11.74%) with higher rates, but they were classified as effect. They were not classified as a cause because their outcomes can be strongly impacted by the other criteria (e.g., efficacy and safety). HTA experts also classified HRQoL as the most important criterion (11.01%), but in this case as an effect. OS was the second most important (10.98%), followed by safety criteria (10.03%). Category analysis showed that efficacy was the most important criteria for all groups. Safety and economic category alternated between the second and third position, except for patients which included HRQoL as the second main category. This study ranked criteria set according to four experts groups using DEMATEL. Efficacy was the main category, followed by safety or economic (except for patients, which included HRQoL).