The optimal management of advanced ‘unresectable' Non-Small Cell Lung Cancer (NSCLC) has not been established. Local clinicians identified a need to review and update existing Northern Ireland clinical guidance.

The Analytic Hierarchy Process (AHP) is an explicit quantitative decision methodology, which can be used to support group consensus development. This case study examined the application of an AHP Framework to support the relative valuation of competing NSCLC treatment regimens in a local context.

A preliminary scoping review of the topic was conducted to determine appropriate parameters for the topic. Factors considered important in comparisons between lung cancer treatment regimens were identified, defined and structured in an Evaluation Hierarchy. The relative importance of each Evaluation Criteria, in the context of different NSCLC patient populations, was derived from Group pairwise judgements (Figure 1 ).

Evaluation Models were agreed for 3 different clinical approaches - Radical Radiotherapy, Radical Chemoradiotherapy, and Palliative Chemotherapy. Relevant evidence for each regimen was identified, appraised and summarised to support pairwise judgements. The ‘most appropriate' Option was determined by derivation of composite (ratio-level) priority scores (Figure 2).

The Group considered the AHP output and its sensitivity analysis. It was concluded that the AHP Framework helped focus discussion, clarify the areas of consensus in the Group and set out a more rational basis for agreement.

Figure 1. Evaluation Criteria Group Priority Scores

Figure 2. Evaluation Models – composite priority scores for regimens