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Cost-Effectiveness of Daratumumab or Bortezomib Added to Lenalidomide Plus Dexamethasone in Newly Diagnosed MM
Among 3 chemotherapy treatment regimens for patients with newly diagnosed multiple myeloma (MM), lenalidomide plus dexamethasone (Rd) was found to be the most cost-effective in a study published in the Journal of Managed Care and Specialty Pharmacy (2021;27[12]:1691-1702. doi:10.18553/jmcp.2021.27.12.1691).
“There have been cost-effectiveness analyses for daratumumab and bortezomib use in [relapsed or refractory] MM, but there are limited data regarding cost-effectiveness for daratumumab or bortezomib use in newly diagnosed [MM] patients who are ineligible for stem cell transplantation,” wrote Nihal Narsipur, PharmD, UCSF-Actelion Clinical Research and Medical Communications Fellow, University of California, San Francisco, and colleagues.
This study aimed to compare the cost-effectiveness of 3 regimens for patients with MM ineligible for autologous stem cell transplantation: (1) daratumumab, lenalidomide, and dexamethasone triple therapy (DRd); (2) bortezomib and lenalidomide plus dexamethasone triple therapy (VRd); and (3) Rd.
Researchers developed a 2-state Markov model using a US health system perspective and a lifetime time horizon. Progression-free survival data were obtained from the phase 3 MAIA and SWOG S0777 randomized controlled trials and were used to calculate transition probabilities.
Costs were derived from national data sources and reported in 2019 US dollars, discounted by 3%. The study assumed a treatment would be cost-effective at a willingness-to-pay (WTP) threshold of $150,000 per progression-free quality-adjusted life year (QALY). Researchers conducted one-way and probabilistic sensitivity analyses.
The treatment with the lowest overall cost was Rd at $329,867, followed by VRd at $385,434 and DRd at $626,900. Treatment with Rd resulted in 1.24 progression-free QALYs, VRd resulted in 1.35 progression-free QALYs, and DRd resulted in 1.52 progression-free QALYs.
At a WTP threshold of $150,000 per progression-free QALY, VRd was not cost-effective vs Rd, with an incremental cost-effectiveness ratio (ICER) of $530,256 per progression-free QALY. DRd was not cost-effective vs VRd with an ICER of $1,396,318 per progression-free QALY. In addition, DRd was not cost-effective compared to Rd, with an ICER of $1060,832 per progression-free QALY.
Results from one-way sensitivity analysis demonstrated that the model was sensitive to costs of DRd, VRd, and Rd. Results from probabilistic sensitivity analysis showed that VRd was cost-effective at a WTP threshold of $550,000 for 40% of iterations. There were no reasonable WTP thresholds, up to $800,000, where DRd was more cost-effective than VRd.
“This study is the first analysis to directly compare the cost-effectiveness of 3 acceptable chemotherapy treatment regimens for patients with [MM] ineligible for autologous stem cell transplant. Neither DRd nor VRd triple therapy were found to be cost-effective vs Rd,” concluded Dr Narsipur and colleagues.
