CRITICAL ANALYSIS OF THE “REGIONAL HEALTH TECHNOLOGY ASSESSMENT REPORT ON THE IMPLICATIONS OF BEVACIZUMAB USE IN ADULT PATIENTS WITH METASTATIC COLORECTAL CANCER (DIME, 2015)”

OBJECTIVES: Analyze the results obtained in DIME-BID HTA for the treatment of metastatic colorectal cancer (mCRC). METHODS: a methodological analysis of the HTA presented by the DIME was performed. Focused on three parameters (research question, hypothesis, evidence and economic analysis). RESULTS: The efficacy of Bevacizumab for the treatment of mCCR has been tested in a Phase IV clinical trial, seven phase III clinical trials, two meta-analyzes and more than 25 scientific papers concluding that Bevacizumab is more effective Than chemotherapy in the first line treatment of mCRC. Despite the strong scientific evidence, the HTA published by DIME "Regional Technology Assessment Report on the Implications of the Use of Bevacizumab in Adult Patients with Metastatic Colorectal Cancer (Jul, 2015)" concludes that in first Line there is no difference in efficacy between Bevacizumab and chemotherapy. The results obtained were due to poor selection of evidence, a consequence of an inconsistent research question and a structure that did not establish necessary parameters to measure the question. Most troubling is the quality of evidence the authors used. The ITACA trial, despite being phase III, does not have enough external validity due to the small population, which resulted on an efficacy outcome incongruent with previous clinical trials. It is clear that the alarming negative results are a direct result of the inadequate HTA structure and the limitation in the selection of scientific evidence. CONCLUSIONS: If the published and accepted evidence reflects a superiority of Bevacizumab in efficacy versus the different forms of chemotherapy for the treatment of first-line mCRC, DIME should have not opted for a cost minimization analysis that implies equivalence in efficacy of Bevacizumab and chemotherapy. Therefore, the DIME decision to opt for a cost minimization analysis is considered a conceptual problem from the point of view of health economics.