A proposed measurable residual disease (MRD) decision framework at Emory demonstrates cost savings and improved health outcomes for patients with multiple myeloma (MM) initiating maintenance therapy, according to a study presented at the virtual 62nd Annual American Society of Hematology (ASH) Annual Meeting and Exposition.
This study was presented by Josh J Carlson, MPH, PhD, University of Washington, Seattle.
“Right now, maintenance therapy post-transplant is recommended [for MM] but this should be in the context of shared decision making with patients. An NGS MRD inform clinical pathway can support this decision making and may lead to the ability to discontinue treatment, have therapeutic holidays, lower costs, and potentially improve quality of life due to avoidance of adverse events,” explained Dr Carlson during his presentation.
The study aimed to evaluate the potential cost-effectiveness and cost savings associated with the proposed Emory MRD decision framework applied to the use of NGS MRD for clinical decision making in the setting post-transplant maintenance therapy for MM.
An annual probability of achieving sustained MRD negativity while on maintenance therapy was estimated at 21%, based on data from Emory also presented during the ASH Meeting. Additionally, it was assumed, based on institutional data that 198 patients would initiate maintenance treatment under this pathway this year.
The costs of NGS MRD, lenalidomide maintenance, and treatment for relapsed patients were $1950, $21,364/month, and $29,798/month based on list prices, wholesale acquisition costs, and peer reviewed literature, respectively. A US health system perspective and a 3% discount rate were used.
MRD testing yielded an estimated lifetime savings of $916,000 per patient and $181,000,000 for an annual cohort or patients at Emory. Additionally, health outcomes were improved by 0.009 quality adjusted life years with MRD testing compared with no testing.
“By way of conclusion, the proposed MRD decision framework is estimated to save costs and potentially improve health outcomes for MM patients initiating the maintenance treatment after transplant,” Dr Carlson concluded.
“We do suggest that ongoing clinical studies and additional studies are warranted given the potential large cost savings in the high uncertainty in this space,” he added.—Janelle Bradley
Carlson JJ, Zimmermann M, Demaree A, Hewitt T, Eckert B, Nooka A. Cost-Effectiveness of Implementing Clonoseq NGS-MRD Testing Using the Emory MRD Decision Protocol in Multiple Myeloma. Presented at: the 62nd ASH Annual Meeting and Exposition; Dec 5-8, 2020. Abstract 3426.
