DP052 | PREFERENCES FOR TREATMENT IN FIRST-LINE CHRONIC LYMPHOCYTIC LEUKEMIA: A MULTI-CRITERIA DECISION ANALYSIS IN ITALY

BACKGROUND: Various novel targeted first-line (1L) treatments (tx) are recommended for CLL. This study aimed to identify key criteria for selecting 1L CLL tx for patients (pts) with mutated or unmutated IGHV (IGHV^mut/IGHV^unmut) and evaluate the relevance of the criteria for Italian stakeholders. METHODS: A MCDA was developed per the ISPOR MCDA Emerging Good Practices Task Force. A multi-stakeholder group of clinicians, methodologists/payers, and pts was formed. Targeted tx reimbursed in Italy were chosen per ESMO guidelines, including Bruton tyrosine kinase inhibitors (BTKis; acalabrutinib, ibrutinib (I), zanubrutinib), venetoclax (V) + obinutuzumab, and VI. Criteria for 1L CLL tx were selected through literature review, stakeholder discussion, and data availability. A performance matrix was built using data from clinical trials and literature to assign values to each tx and criterion. Preferences between criteria (weighting) and for changes within criteria (scoring) were assessed by 20 stakeholders (9 clinicians, 6 methodologists/payers, 5 pts) via the Measuring Attractiveness by a Categorical-Based Evaluation Technique (MACBETH) method. Mean weight percentages reflect each criterion’s relative importance. Global scores per tx were calculated by combining scores of the alternatives for each criterion with respondent-assigned weights. RESULTS: The chosen criteria were efficacy (progression-free survival), safety (tx discontinuations due to adverse events), drug cost, quality of life, convenience of administration, and tx duration (Table). In pts with IGHV^mut, efficacy was most relevant for pts and payers (23% each); clinicians prioritized tx duration (24%). Compared with pts with IGHV^mut, mean weight of efficacy in pts with IGHV^unmut increased for all stakeholders, and was the most important criterion for clinicians (36%) and payers (30%); the most important criteria for pts were safety (27%) and efficacy (26%). Only efficacy and safety had mean weights ≥20% in all groups regardless of IGHV mutation; drug cost and convenience of administration did not reach 20%. In pts with IGHV^mut, mean global scores were highest for zanubrutinib for pts and payers and VI for clinicians. In pts with IGHV^unmut, second-generation BTKis had the highest score. CONCLUSIONS: Efficacy and safety were most important for Italian stakeholders in 1L CLL tx decisions regardless of IGHV mutation status, except for clinicians of pts with IGHV^mut, for whom tx duration was most important.