The Contribution of Dostarlimab to First-Line Treatment of Advanced or Recurrent Endometrial Cancer in Spain: A Multi-Criteria Decision Analysis Approach.

Objectives: To estimate the added value of dostarlimab compared to durvalumab and pembrolizumab as first-line treatment for adult patients with primary advanced or recurrent endometrial cancer (EC) in Spain using a Multi-Criteria Decision Analysis (MCDA) framework. Methods: Following the Evidence and Value: Impact on Decision Making (EVIDEM) framework and International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommendations, 25 Spanish experts (12 medical oncologists and 13 hospital pharmacists) weighted and scored 11 quantitative and 5 qualitative criteria based on an evidence matrix from a literature review. Results: Efficacy and safety were weighted as the most important criteria. Dostarlimab showed positive added value in both comparisons with scores of 0.58 versus durvalumab/durvalumab + olaparib and 0.50 versus pembrolizumab. Dostarlimab and pembrolizumab are the only therapies reimbursed in the Spanish public health system; therefore, their comparative assessment is of clinical and strategic relevance. While pembrolizumab may show longer progression-free survival (PFS) and response duration in specific subgroups, the evidence for dostarlimab-including a statistically significant improvement in overall survival (OS) in the overall population as a primary endpoint, more robust data, and favorable long-term quality-of-life outcomes-was considered by the expert panel to support a more favorable assessment. Conclusions: Within the MCDA framework, experts consider dostarlimab an option with a higher value contribution for adult patients with primary advanced or recurrent EC. Its clinical benefits, improved quality-of-life outcomes, and alignment with healthcare priorities promote treatment continuity and adherence in clinical practice. MCDA provided a transparent approach for multidimensional evaluation of these therapies.