Cost-effectiveness of adding daratumumab or bortezomib to lenalidomide plus dexamethasone for newly diagnosed multiple myeloma

• DOI: 10.18553/jmcp.2021.27.12.1691
• Publication Date: 2021-11-24T18:19:28Z
• Authors: Nihal Narsipur; Sabrina Bulla; Connie Yoo; Brenda Do; Kyle Tran; Dian Gu; Lixian Zhong; Leslie Wilson
• Keywords: Daratumumab; Autologous stem-cell transplantation

BACKGROUND: Multiple myeloma survival rates are steadily increasing due to availability of new drug classes used in combination with corticosteroids and chemotherapy. The latest treatments daratumumab or bortezomib therapy lenalidomide dexamethasone (Rd). Daratumumab, a CD38-targeted, human IgG1k monoclonal antibody, bortezomib, proteasome inhibitor, both approved as regimens for transplant-ineligible relapsed/refractory multiple (RRMM). There have been cost-effectiveness analyses use RRMM, but there limited data regarding newly diagnosed patients who ineligible stem cell transplantation. OBJECTIVE: To compare the 3 separate regimens-(1) daratumumab, lenalidomide, triple (DRd); (2) plus (VRd); (3) (Rd)-in autologous transplant. METHODS: A 2-state Markov model was developed using US health system perspective lifetime time horizon. Transition probabilities were calculated from progression-free reported two phase randomized controlled trials-MAIA SWOG S0777-and extrapolated Weibull distribution based on Hoyle Henley method. National sources obtain costs 2019 dollars, discounted by 3%. Health state utilities available literature applied each state. Utility decrements adverse events individualized choice branch utility decrement weighted percentage experienced event MAIA S0777 trials. We assumed treatment would be cost-effective at willingness pay (WTP) $150,000 per quality-adjusted life-year ($/PFQALY). One-way probabilistic sensitivity conducted. RESULTS: Rd standard had lowest overall cost $329,867, followed VRd $385,434 DRd highest total $626,900. estimated result least amount (1.24) PFQALYs, 1.35 PFQALYs 1.52 PFQALYs. With WTP threshold PFQALY, not compared therapy, an incremental ratio (ICER) $530,256 PFQALY. (ICER = $1,396,318 PFQALY), nor $1060,832). analysis showed that our sensitive DRd, VRd, drugs. Probabilistic only $550,000 40% iterations. no reasonable thresholds, up $800,00, where became more than VRd. CONCLUSIONS: This study is first directly acceptable chemotherapy Neither found vs Rd. Further include therapies needed demonstrate ICER QALYs. DISCLOSURES: No funding received this study. At study, Narsipur UCSF-Actelion Clinical Research Medical Communications Fellow, unrelated other authors nothing disclose.