Cost Savings with Bortezomib, Cyclophosphamide, and Dexamethasone

New Orleans—Patients with untreated multiple myeloma had a cost savings of approximately $29,000 per treatment course if they received bortezomib, cyclophosphamide, and dexamethasone (BCD) compared with a group taking bortezomib, lenalidomide, and dexamethasone (BLD), according to a retrospective, observational study. Response rates, progression-free survival, and overall survival were comparable in the groups.

Results were presented during a poster presentation at the ASH meeting. The poster was titled Comparable Outcomes and Lower Drug Costs per Treatment Course with Bortezomib-Cyclophosphamide-Dexamethasone versus Bortezomib-Lenalidomide-Dexamethasone for Initial Treatment of Newly Diagnosed Multiple Myeloma.

In phase 2 trials, the BCD and BLD regimens were effective in terms of tumor response and tolerability, according to the authors. They added that the combination treatments are common in first-line and relapsed settings.

In this analysis, the authors were interested in comparing the regimens in routine clinical settings and examining costs and adverse events. They included patients who were at least 18 years of age who began treatment at the Mayo Clinic in Rochester, Minnesota or within the US Oncology Network from 2008 to 2013. They extracted data on baseline characteristics, laboratory findings, dosing regimens, duration of treatment, reasons for discontinuation, clinical outcomes, adverse events, and total drug costs per treatment course.

The study included 106 patients who received BCD (61 from the Mayo Clinic and 45 from US Oncology Network) and 84 patients who received BLD (39 from the Mayo Clinic and 45 from US Oncology Network). However, 5 BCD patients and 9 BLD patients were excluded because they were treated in a clinical trial. At baseline, the characteristics were similar within the groups, although the BCD group had more comorbidities. The mean age was approximately 62 years of age, and 55% were male.

The mean treatment duration was 5.1 months in the BCD group and 5.4 months in the BLD group (P=.6386), while the mean number of equivalent 21-day cycles was 6.6 in the BCD group and 6.3 in the BLD group (P=.5522)

At 1 year, the progression-free survival rates were 72.6% in the BCD group and 70.8% in the BLD group (P=.9071), while the overall survival rates were 90.8% and 96.4% , respectively (P=.0999). After 2 years of treatment, the progression-free survival rates were 66.6% in the BCD group and 63.2% in the BLD group (P=.9332), while the overall survival rates were 90.8% and 87.4% , respectively (P=.3341).

The most common adverse events were fatigue, anemia, and peripheral neuropathy.

The mean total drug costs per treatment course were $37,181 for patients receiving BCD and $66,649 for patients in the BLD group (P<.0001). When the authors calculated drug costs based on dosing schedules, they found total drug costs per treatment course were $37,049 with BCD and $70,790 with BLD (P<.0001).

The authors noted a few limitations of their analysis. They mentioned a longer study would be desirable because the mean duration of observation was <1.5 years and the median progression-free survival and overall survival were not reached for both groups. They also had limited data on the causes of adverse events and mentioned that they could have been due to the treatment regimens, baseline comorbidities, or other factors. Finally, the study only examined an oncology center and a community oncology practice network, so the findings may differ in other settings.

This study was funded by Millenium: The Takeda Oncology Company.