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Cost Effectiveness and Resource Allocation
Published in: Cost Effectiveness and Resource Allocation 1/2024

Open Access 01-12-2024 | Daratumumab | Research

Cost-effectiveness and budget impact analysis of Daratumumab, Lenalidomide and dexamethasone for relapsed-refractory multiple myeloma

Authors: Zahra Goudarzi, Rahil Sadat Shahtaheri, Zhila Najafpour, Haleh Hamedifar, Hamidreza Ebrahimi

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2024

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Abstract

Background

The prominent efficacy in terms of increasing progression-free survival (PFS) of Daratumumab, Lenalidomide and dexamethasone (DRd) triplet therapy versus Carfilzomib, Lenalidomide and dexamethasone (KRd) was proven previously in relapsed-refractory multiple myeloma (RRMM). However, the cost effectiveness of DRd versus KRd is unknown.

Methods

We developed a Markov model by using an Iranian payer perspective and a 10-year time horizon to estimate the healthcare cost, Quality-adjusted life years (QALYs) and life years gain (LYG) for DRd and KRd triplet therapies. Clinical data were obtained from meta-analyses and randomized clinical trials (RCTs). One-way and probabilistic sensitivity analysis were performed to assess model uncertainty. Budget impact analysis of 5 years of treatment under the DRd triplet therapy was also analysed.

Results

DRd was estimated to be more effective compared to KRd, providing 0.28 QALY gain over the modelled horizon. DRd-treated patients incurred $264 in total additional costs. The incremental cost utility ratio (ICUR) and cost effectiveness ratio (ICER) were $956/QALY and $472/LYG respectively.
The budget impact analysis indicates that adding Daratumumab to Lenalidomide and dexamethasone regimen, in the first 5 years, will increase the healthcare system’s expenses by $6.170.582.

Conclusion

DRd triplet therapy compared to KRd is a cost-effective regimen for RRMM under Iran willingness-to-pay threshold.
Literature
1.
Barlogie B, Mitchell A, van Rhee F, Epstein J, Morgan GJ, Crowley J. Curing myeloma at last: defining criteria and providing the evidence. Blood. 2014;124(20):3043–51.CrossRefPubMedPubMedCentral
2.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.CrossRefPubMed
3.
4.
Ramsenthaler C, Osborne TR, Gao W, Siegert RJ, Edmonds PM, Schey SA, et al. The impact of disease-related symptoms and palliative care concerns on health-related quality of life in multiple myeloma: a multi-centre study. BMC Cancer. 2016;16:427.CrossRefPubMedPubMedCentral
5.
Kleber M, Ihorst G, Terhorst M, Koch B, Deschler B, Wäsch R, et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM-comorbidity score. Blood Cancer J. 2011;1(9): e35.CrossRefPubMedPubMedCentral
6.
Rizzo M, Xu Y, Panjabi S, Iheanacho I. A systematic literature review of the economic burden in multiple myeloma. Val Health. 2014;17(7):A628.CrossRef
7.
Pulte D, Redaniel MT, Brenner H, Jansen L, Jeffreys M. Recent improvement in survival of patients with multiple myeloma: variation by ethnicity. Leuk Lymphoma. 2014;55(5):1083–9.CrossRefPubMed
8.
9.
Chen Y, Lairson DR, Chan W, Huo J, Du XL. Cost-effectiveness of novel agents in medicare patients with multiple myeloma: findings from a U.S. payer’s perspective. J Manag Care Spec Pharm. 2017;23(8):831–43.PubMed
10.
Dimopoulos MA, Moreau P, Terpos E, Mateos MV, Zweegman S, Cook G, et al. Multiple myeloma: EHA-ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32(3):309–22.CrossRefPubMed
11.
Stewart AK, Rajkumar SV, Dimopoulos MA, Masszi T, Špička I, Oriol A, et al. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med. 2015;372(2):142–52.CrossRefPubMed
12.
Dimopoulos MA, Moreau P, Palumbo A, Joshua D, Pour L, Hájek R, et al. Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): a randomised, phase 3, open-label, multicentre study. Lancet Oncol. 2016;17(1):27–38.CrossRefPubMed
13.
14.
15.
Siegel DS, Dimopoulos MA, Ludwig H, Facon T, Goldschmidt H, Jakubowiak A, et al. Improvement in overall survival with carfilzomib, lenalidomide, and dexamethasone in patients with relapsed or refractory multiple myeloma. J Clin Oncol. 2018;36(8):728–34.CrossRefPubMed
16.
Dimopoulos M, Wang M, Maisnar V, Minarik J, Bensinger W, Mateos M-V, et al. Response and progression-free survival according to planned treatment duration in patients with relapsed multiple myeloma treated with carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide and dexamethasone (Rd) in the phase III ASPIRE study. J Hematol Oncol. 2018;11(1):1–9.CrossRef
17.
Dimopoulos MA, Stewart A, Masszi T, Špička I, Oriol A, Hajek R, et al. Carfilzomib–lenalidomide–dexamethasone vs lenalidomide–dexamethasone in relapsed multiple myeloma by previous treatment. Blood Cancer J. 2017;7(4): e554.CrossRefPubMedPubMedCentral
18.
Chng W, Goldschmidt H, Dimopoulos M, Moreau P, Joshua D, Palumbo A, et al. Carfilzomib–dexamethasone vs bortezomib–dexamethasone in relapsed or refractory multiple myeloma by cytogenetic risk in the phase 3 study ENDEAVOR. Leukemia. 2017;31(6):1368–74.CrossRefPubMedPubMedCentral
19.
20.
McKeage K, Lyseng-Williamson KA. Daratumumab in multiple myeloma: a guide to its use as monotherapy in the EU. Drugs Ther Perspect. 2016;32(11):463–9.CrossRef
21.
Palumbo A, Chanan-Khan A, Weisel K, Nooka AK, Masszi T, Beksac M, et al. Daratumumab, bortezomib, and dexamethasone for multiple myeloma. N Engl J Med. 2016;375(8):754–66.CrossRefPubMed
22.
Dimopoulos MA, Oriol A, Nahi H, San-Miguel J, Bahlis NJ, Usmani SZ, et al. Daratumumab, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2016;375(14):1319–31.CrossRefPubMed
23.
Blair HA. Daratumumab: a review in relapsed and/or refractory multiple myeloma. Drugs. 2017;77(18):2013–24.CrossRefPubMed
24.
Luo XW, Du XQ, Li JL, Liu XP, Meng XY. Treatment options for refractory/relapsed multiple myeloma: an updated evidence synthesis by network meta-analysis. Cancer Manag Res. 2018;10:2817–23.CrossRefPubMedPubMedCentral
25.
Abdoli G. Estimation of social discount rate for Iran. Econ Res. 2009;9(34):135–56.
26.
Maiese EM, Ainsworth C, Le Moine J-G, Ahdesmäki O, Bell J, Hawe E. Comparative efficacy of treatments for previously treated multiple myeloma: a systematic literature review and network meta-analysis. Clin Ther. 2018;40(3):480-94.e23.CrossRefPubMed
27.
Facon T, Kumar SK, Plesner T, Orlowski RZ, Moreau P, Bahlis N, et al. Daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone alone in newly diagnosed multiple myeloma (MAIA): overall survival results from a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(11):1582–96.CrossRefPubMed
28.
Facon T, Kumar S, Plesner T, Orlowski RZ, Moreau P, Bahlis N, et al. Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. N Engl J Med. 2019;380(22):2104–15.CrossRefPubMedPubMedCentral
29.
Pelligra CG, Parikh K, Guo S, Chandler C, Mouro J, Abouzaid S, et al. Cost-effectiveness of pomalidomide, carfilzomib, and daratumumab for the treatment of patients with heavily pretreated relapsed-refractory multiple myeloma in the United States. Clin Ther. 2017;39(10):1986-2005.e5.CrossRefPubMed
30.
Mozayani AH, Sahabi B, Asadi M. Estimating social discount rate trend in Iran. Iran Econ Rev. 2021;25(2):191–203.
31.
Janbabai G, Yaghoubi Ashrafi M, Mousavi R, Shekarriz R, Eslami Jouybari M, Zaboli E, et al. Epidemiology of hematopoietic cancers in north of Iran: results of Mazandaran population-based cancer registry. WCRJ. 2019;6: e1270.
32.
Majer I, Kroep S, Maroun R, Williams C, Klijn S, Palmer S. Estimating and extrapolating survival using a state-transition modeling approach: a practical application in multiple myeloma. Val Health. 2022;25(4):595–604.CrossRef
33.
Dumontet C, Hulin C, Dimopoulos MA, Belch A, Dispenzieri A, Ludwig H, et al. A predictive model for risk of early grade≥ 3 infection in patients with multiple myeloma not eligible for transplant: analysis of the FIRST trial. Leukemia. 2018;32(6):1404–13.CrossRefPubMedPubMedCentral
34.
Wong XY, Chng WJ, Aziz MIA, Ng K. Cost-effectiveness of daratumumab in combination with lenalidomide and dexamethasone for relapsed and/or refractory multiple myeloma. Expert Rev Pharmacoecon Outcomes Res. 2022;22(2):207–15.CrossRefPubMed
35.
Narsipur N, Bulla S, Yoo C, Do B, Tran K, Gu D, 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):1691–702.PubMed
36.
Zhang TT, Wang S, Wan N, Zhang L, Zhang Z, Jiang J. Cost-effectiveness of daratumumab-based triplet therapies in patients with relapsed or refractory multiple myeloma. Clin Ther. 2018;40(7):1122–39.CrossRefPubMed
Metadata
Title
Cost-effectiveness and budget impact analysis of Daratumumab, Lenalidomide and dexamethasone for relapsed-refractory multiple myeloma
Authors
Zahra Goudarzi
Rahil Sadat Shahtaheri
Zhila Najafpour
Haleh Hamedifar
Hamidreza Ebrahimi
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Cost Effectiveness and Resource Allocation / Issue 1/2024
Electronic ISSN: 1478-7547
DOI
https://doi.org/10.1186/s12962-024-00525-4

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