Primary Risk Drivers
Below is a snapshot of domains that materially influence the MARA Rating.
Clinical effectiveness
Trabectedin shows moderate clinical benefit over existing treatments for advanced soft tissue sarcoma, with median overall survival of 13.9 months compared to 6.6 months for historical controls. However, the evidence is primarily based on a Phase 2 trial and historical controls, limiting the robustness of the findings.
Cost effectiveness
The incremental cost-effectiveness ratio (ICER) for trabectedin is approximately £34,500 per QALY gained, which is within acceptable thresholds for cost-effectiveness. The model appears robust, and the patient access scheme further enhances its economic viability.
Quality of life
No health-related quality of life data were presented for patients with advanced soft tissue sarcoma, and the manufacturer acknowledged that none were obtained from the trials. This absence of data leads to a lack of understanding of the treatment’s impact on patients’ quality of life.
Supporting Domains
Safety and Adverse Effects
Trabectedin has a very good safety profile, with most adverse effects being transient and reversible. The absence of cardiotoxicity or neurotoxicity, along with manageable adverse reactions, supports a strong safety profile compared to other chemotherapy agents.
Comparator Selection
The trials primarily used historical controls for comparison, which raises concerns about the validity of the evidence. While the use of historical controls is acknowledged due to the rarity of the condition, it limits the strength of the comparative effectiveness data.
Patient Population and Subgroups
The trial population included patients with advanced soft tissue sarcoma who had previously failed treatment with anthracyclines and ifosfamide. The inclusion of patients with liposarcomas and leiomyosarcomas supports the generalizability of the findings to the intended patient population.
Care Pathway Integration
Trabectedin can be integrated into existing care structures for advanced soft tissue sarcoma, typically managed by specialists in outpatient settings. This seamless integration indicates minimal disruption to current treatment pathways.
Resource Use and Cost Implications
The economic evaluation indicates that the resource use associated with trabectedin is manageable, especially with the patient access scheme in place. The overall budget impact appears justifiable given the treatment’s benefits.
Evidence Quality and Robustness
While the evidence from the STS-201 trial is significant, it is primarily based on Phase 2 data and historical controls, which introduces limitations and biases. The reliance on historical data for comparators raises concerns about the robustness of the evidence.
Uncertainty, Sensitivity, and Broader Impacts
The uncertainties related to the cost-effectiveness model are acknowledged, but the overall context of unmet need and the potential benefits of trabectedin support its use. The treatment addresses a significant gap in options for patients with advanced soft tissue sarcoma.
