{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T23:57:19Z","timestamp":1784591839802,"version":"3.55.0"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["381508\/2023-4 \/ 381828\/2022-0 [sholarships]"],"award-info":[{"award-number":["381508\/2023-4 \/ 381828\/2022-0 [sholarships]"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["400224\/2022-4"],"award-info":[{"award-number":["400224\/2022-4"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The objective of this study was to present the use of the Problem, Objectives, Alternatives, Consequences, Trade-offs, Uncertainty, Risk, and Linked decisions (PrOACT-URL) and multi-criteria decision analysis (MCDA) frameworks as a methodological innovation with the potential to support decision-making in the process of incorporating and monitoring technologies in the Brazilian Unified Health System (SUS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The present is a case study that used these frameworks as a basis for the benefit-risk assessment (BRA) of chemotherapy treatment options for multiple myeloma (MM) in the context of a Brazilian public hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The application of the PrOACT-URL was not sufficient to guide stakeholders in making decisions about the best treatment alternative for MM, making it necessary to complement the qualitative analysis with the MCDA. In general, comparing the average scores for the five treatment options, the overall survival result was higher in four of the five treatments available for MM. The results that presented the lowest score were the risk of thrombosis and the risk of neuropathy. The sensitivity analysis showed that, for most stakeholder groups (managers, academia and clinicians), the treatment with the highest total value in the ranking was treatment with cyclophosphamide, thalidomide and dexamethasone (CTD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The present case study showed that cyclophosphamide, thalidomide and dexamethasone presented the best benefit-risk balance for the treatment of MM and highlights the importance of the complementarity of these two structured approaches for more transparent decision-making, with an expansion of the deliberative process and the incorporation of preferences from different stakeholders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10781552251374555","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T13:28:51Z","timestamp":1756992531000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["PrOACT-URL and MCDA for benefit-risk assessment in multiple myeloma: A case study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7702-3567","authenticated-orcid":false,"given":"Sidney Marcel","family":"Domingues","sequence":"first","affiliation":[{"name":"Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1752-6095","authenticated-orcid":false,"given":"Erica Aranha","family":"Suzumura","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Avalia\u00e7\u00e3o de Tecnologias em Sa\u00fade no Centro de Investiga\u00e7\u00e3o Translacional em Oncologia, Instituto do C\u00e2ncer do Estado de S\u00e3o Paulo - ICESP, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0233-0797","authenticated-orcid":false,"given":"Alessandro Gon\u00e7alves","family":"Campolina","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Laborat\u00f3rio de Avalia\u00e7\u00e3o de Tecnologias em Sa\u00fade no Centro de Investiga\u00e7\u00e3o Translacional em Oncologia, Instituto do C\u00e2ncer do Estado de S\u00e3o Paulo - ICESP, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8383-0728","authenticated-orcid":false,"given":"Patr\u00edcia Coelho","family":"de Soarez","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3636"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/2042098620976951"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3958"},{"key":"e_1_3_2_5_2","unstructured":"European Medicines Agency. 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