Cost and Utilization of Daratumumab in Patients With Multiple Myeloma

Patients with multiple myeloma (MM) received an average of 14% more doses of daratumumab during the first year of treatment than recommended on the label approved by the US Food and Drug Administration (FDA), according to a retrospective, observational, database analysis (Future Oncol. 2022:18(3):301-309; doi: 10.2217/fon-2021-1072). The analysis also found that continuing intensive daratumumab dosing after the initial 4 months of treatment increased one-year treatment costs by more than $31,000, an estimate based on Medicare’s average sales price for daratumumab.

“The cost of cancer therapies, including novel antibody-based therapies, is a major and pressing concern in cancer care delivery…These data provide an important first look at the dosing patterns of daratumumab in the real-world setting and provide a framework for further analyses of dosing practices and their impact and cost estimation for daratumumab treatment in MM,” wrote Lucio Gordan, MD, Florida Cancer Specialists, Gainesville, FL, and colleagues.

Daratumumab has improved outcomes in patients with MM and, thus, become the mainstay of many MM treatment regimens since the FDA approved it in 2015. Nevertheless, community oncologists often continue giving weekly or biweekly doses of this anti-CD38 monoclonal antibody (mAb) instead of transitioning to monthly dosing after the first 16 weeks of treatment as recommended on the FDA-approved label.

“This has a measurable impact on the cost of care, and dosing overcompliance is not supported by any published findings that indicate an improvement in patient outcomes,” Dr Gordan and team noted, adding, “this may drive unforeseen consequences such as increased infections, infusion site reactions, and development of cytopenias.”

To conduct the analysis, Dr Gordan and team used the Integra Connect database, which included 13 community oncology network accounts and 1200 US providers, to collect data on all patients with MM treated with daratumumab from January 2016 through March 2020. Patients who received daratumumab for transplant induction were excluded from the analysis. Only data regarding treatment with the infused mAb were included because the subcutaneous formulation had not yet been approved at the time the study was conducted.

The researchers included 1037 patients in the study group, whose mean age was 66 years. Slightly more men (53%) than women (42%) were included in the study. After 6 months of treatment, 671 patients (65%) continued to receive daratumumab, and 330 (49%) of these patients received daratumumab more frequently than specified by the standard dosing schedule. 

As a result, the estimated total daratumumab treatment cost for the entire study cohort was nearly $200,000. This cost is substantially greater than the cost of daratumumab treatment for the entire cohort would be if the standard dosing schedule were used exclusively.

To account for their findings, Dr. Gordan and team hypothesized that “physicians may maintain daratumumab as the backbone of therapy and switch another drug such as bortezomib to an immunomodulatory agent, or vice versa, when there is evidence of disease progression,” concluding that when the regimen is changed, “it is possible that reloading of daratumumab dosing (weekly ramp-up) occurs.”