A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in the United States of America

Roodman, G. David; Willenbacher, Wolfgang; Shimizu, Kazuyuki; Terpos, Evangelos; Kennedy, Lisa; Sabatelli, Lorenzo; Intorcia, Michele; Hechmati, Guy

doi:10.1080/13696998.2018.1445634

Cited by 19 publications

(52 citation statements)

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“…The cost-effectiveness of denosumab vs ZA in patients with MM was analyzed using a decision analytical model that was based on the XGEVA global economic model (X-GEM) for patients with MM developed by Raje et al 31 . The X-GEM is a partitioned-survival semi-Markov model.…”

Section: Cost-effectiveness Analysismentioning

confidence: 99%

“…The model population comprised adults with newly-diagnosed MM from the 20090482 study 20 . Patients were enrolled over a 45-month period, with a median follow-up of 17.3 and 17.6 months in the denosumab and ZA arms, respectively 20,31 . Eligible patients had at least one lytic bone lesion 20 .…”

Section: Model Populationmentioning

confidence: 99%

“…The following clinical outcomes were included in the model: SRE annual rates by treatment status and the distribution of SREs by type; PFS and OS rates; treatment-discontinuation and -compliance rates; and serious adverse event (SAE) rates (Supplementary Table S1) 20,21,[31][32][33] . The clinical inputs from the 20090482 study 20 were used for all four countries.…”

Section: Model Clinical Inputsmentioning

confidence: 99%

“…As modern healthcare systems have competing demands on HRU and spending 29 , it is increasingly important to demonstrate the value of novel treatments to multiple stakeholders 30 . Using clinical data from the 20090482 study 20 , an economic analysis conducted in the US concluded that denosumab was cost-effective vs ZA for SRE prevention in patients with MM from both a payer and societal perspective 31 . However, there are no published European cost-effectiveness analyses of denosumab in this patient population, and cost-effectiveness results cannot be translated from one healthcare setting to another.…”

Section: Introductionmentioning

confidence: 99%

“…Given the burden of SREs on patients and healthcare systems, the efficacy of denosumab in SRE prevention, and the potential of denosumab to extend PFS vs ZA in patients with MM without impairing renal function, it is important to evaluate the cost-effectiveness of denosumab vs ZA in this patient population. Using the same economic model structure as Raje et al 31 in the US, we estimated the incremental cost-effectiveness ratio (ICER: incremental cost per quality-adjusted life-year [QALY] gained) for denosumab vs ZA from the national healthcare system perspective in four European countries (Austria, Belgium, Greece, and Italy).…”

Section: Introductionmentioning

confidence: 99%

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A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria, Belgium, Greece, and Italy

Terpos

Jamotte

Christodoulopoulou

et al. 2019

Journal of Medical Economics

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Aim: The approved indication for denosumab (120 mg) was expanded in 2018 to include skeletalrelated event (SRE) prevention in patients with multiple myeloma (MM). Therefore, a cost-effectiveness analysis was conducted comparing denosumab with zoledronic acid (ZA) for SRE prevention in patients with MM from the national healthcare system perspective in a representative sample of European countries: Austria, Belgium, Greece, and Italy. Methods: The XGEVA global economic model for patients with MM was used to calculate incremental cost-effectiveness ratios (ICERs) for denosumab vs ZA over a lifetime horizon. Clinical inputs were derived from the denosumab vs ZA randomized, phase 3 study ("20090482") in patients newly-diagnosed with MM, and comprised real-world adjusted SRE rates, serious adverse event (SAE) rates, treatment duration, dose intensity, progression-free survival (PFS), and overall survival (OS). Economic inputs comprised country-specific denosumab and ZA acquisition and administration costs, SRE and SAE management costs, and discount rates. Health utility decrements associated with MM disease progression, SRE and SAE occurrence, and route of administration were included. Results: Estimated ICERs (cost per quality-adjusted life-year [QALY] gained) for denosumab vs ZA in Austria, Belgium, Greece, and Italy were e26,294, e17,737, e6,982, and e27,228, respectively. Using 1-3 times gross domestic product (GDP) per capita per QALY as willingness to pay thresholds, denosumab was 69-94%, 84-96%, 79-96%, and 50-92% likely to be cost-effective vs ZA, respectively. Limitations: Economic inputs were derived from various sources, and time to event inputs were extrapolated from 20090482 study data. Conclusions: Denosumab is cost-effective vs ZA for SRE prevention in patients with MM in Austria, Belgium, Greece, and Italy, based on often-adopted World Health Organization thresholds. This conclusion is robust to changes in model parameters and assumptions. Cost-effectiveness estimates varied across the four countries, reflecting differences in healthcare costs and national economic evaluation guidelines.

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Section: Cost-effectiveness Analysismentioning

confidence: 99%