OBJECTIVES: Establish a multi-criteria decision analysis (MCDA) framework for the value assessment of first-line treatment of adults with advanced, anaplastic lymphoma kinase positive, non-small cell lung cancer (ALK+ NSCLC). Compare value contributions of the second-generation ALK inhibitors, brigatinib and alectinib – within this novel value assessment framework – from a Portuguese physician decision-making viewpoint.

METHODS: Relevant criteria (and levels) were obtained from a literature review of MCDA frameworks, and initial health technology assessment proposals produced by health authorities, related to the treatment of (lung) neoplasms. The initial list was fine-tuned into a final matrix of criteria and levels, contemplating completeness, non-redundancy, non-overlap, and preference independence, during a focus group with Portuguese physicians experienced in the treatment of adults with advanced ALK+ NSCLC. Criteria weights and part-worth utilities for the MCDA framework were elicited from the same physicians through conjoint analysis. Brigatinib and alectinib were assessed on all criteria, considering the most recent publicly available evidence. Final value contributions were expressed as preference shares between both alternatives.

RESULTS: The final MCDA framework included efficacy (four-year overall survival (OS4), one-year progression-free survival (PFS1), intracranial objective response rate (ORR)), safety (discontinuations due to adverse events), and other criteria (change in health-related quality of life (cHRQoL), annual treatment cost, daily pill burden, dosing frequency). cHRQol, OS4 and PFS1 were ranked as the most important criteria, accounting for 62.5% of the total weight in the decision problem, followed by intracranial ORR and annual treatment cost, which represented a further 24.1%. For an estimated 3 out of every 5 patients, brigatinib would be the treatment of choice (preference share: 60.6%).

CONCLUSIONS: The presented value assessment framework provides an objective and transparent method to support medical decision making concerning first-line treatment of adult patients with advanced ALK+ NSCLC, easily adaptable to other geographical regions and treatment settings.