Comparing Cost-Effectiveness of 3 Treatment Regimens for Multiple Myeloma

Compared to 2 other combination treatments, lenalidomide plus dexamethasone was the most cost-effective therapy for patients with newly diagnosed, transplant-ineligible multiple myeloma, according to recent findings.

Researchers compared the cost-effectiveness of daratumumab and lenalidomide plus dexamethasone triple therapy (DRd); bortezomib and lenalidomide plus dexamethasone triple therapy (VRd); and lenalidomide plus dexamethasone (Rd).

“There have been cost-effectiveness analyses for daratumumab and bortezomib use in [relapsed/refractory multiple myeloma], but there are limited data regarding cost-effectiveness for daratumumab or bortezomib use in newly diagnosed multiple myeloma patients who are ineligible for stem cell transplantation,” authors wrote.

The study was conducted using progression-free survival data from the MAIA and SWOG S0777 phase 3 trials, as well as national data on costs, discounted by 3%. Cost-effectiveness was defined as “a willingness to pay of $150,000 per progression-free quality-adjusted life-year” (PFQALY).

Overall costs were $329,867, $385,434, and $626,900 for Rd, VRd, and DRd, respectively. DRd had the highest number of PFQALYs at 1.52, followed by 1.35 PFQALYs for VRd and 1.24 PFQALYs for Rd.

After analyzing costs in accordance with the willingness to pay threshold, researchers found that:

• VRd was not cost-effective compared with Rd standard therapy, with an incremental cost-effectiveness ratio (ICER) of $530,256 per PFQALY;
• DRd was not cost-effective compared with VRd (ICER=$1,396,318 per PFQALY); and
• DRd was also not cost-effective compared with Rd standard therapy (ICER=$1,060,832).

VRd would be cost-effective in 40% of cases if the willingness to pay threshold were increased to $550,000, probabilistic sensitivity analysis indicated. Researchers added that DRd would not be more cost-effective than VRd within any reasonable willingness to pay threshold (up to $800,000).

“Neither DRd nor VRd triple therapy were found to be cost-effective vs Rd,” authors concluded. “Further cost-effectiveness analyses that include overall survival data for daratumumab and bortezomib triple therapies are needed to demonstrate an ICER in QALYs.”

Reference:
Narsipur N, Bulla S, Yoo C, et al. Cost-effectiveness of adding daratumumab or bortezomib to lenalidomide plus dexamethasone for newly diagnosed multiple myeloma. J Manag Care Spec Pharm. 2021; 27(12):1691-1702. doi:10.18553/jmcp.2021.27.12.1691