Multicriteria decision analysis for HER2-positive non-metastatic breast cancer

IntroductionMulticriteria Decision Analysis (MCDA) comprises a set of methods that support decision making in Health Technology Assessment (HTA). MCDA studies that support the incorporation of new treatments for non-metastatic HER2-positive breast cancer are still rare.ObjectiveTo elaborate a MCDA comparing 8 treatments alternatives for women with non-metastatic, HER2+, hormone receptor positive (HR+), postmenopausal breast cancer, who did not achieve a pathological complete response (PCR) after neoadjuvant chemotherapy with taxane plus anti-HER2 therapy.MethodsAn MCDA approach specifically built for application in oncology was used. The study was developed at the Cancer Institute of the State of São Paulo (ICESP) according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommendations.ResultsIt was possible to obtain a ranking of the 8 alternatives: the first, second and third position were respectively: neoadjuvant treatment without anthracycline and anti-HER2 therapy with only trastuzumab followed by adjuvant trastuzumab (global value 0.739); neoadjuvant treatment with anthracycline and anti-HER2 trastuzumab alone followed by adjuvant trastuzumab (global value 0.717) and neoadjuvant treament with anthracycline plus trastuzumab alone or double anti-HER2 blockade with trastuzumab and pertuzumab, followed by adjuvant T-DM1 (global value 0.697). The criteria that received the greatest weight from stakeholders were in descending order: disease-free survival, cost, severity of the disease, adverse reactions and overall survival.ConclusionMCDA made it possible to compare treatment alternatives for non-metastatic, HER2+, HR + breast cancer, with the most innovative technology T-DM1 appearing fourth.