Cost-Effectiveness of Autologous Stem Cell Treatment as Compared to Conventional Chemotherapy for Treatment of Multiple Myeloma in India

Abstract

Recent innovations in treatment of multiple myeloma include autologous stem cell transplantation (ASCT) along with high dose chemotherapy (HDC). We undertook this study to estimate incremental cost per quality adjusted life year gained (QALY) with use of ASCT along with HDC as compared to conventional chemotherapy (CC) alone in treatment of multiple myeloma. A combination of decision tree and markov model was used to undertake the analysis. Incremental costs and effects of ASCT were compared against the baseline scenario of CC (based on Melphalan and Prednisolone regimen) in the patients of multiple myeloma. A lifetime study horizon was used and future costs and consequences were discounted at 5%. Consequences were valued in terms of QALYs. Incremental cost per QALY gained using ASCT as against CC for treatment of multiple myeloma was estimated using both a health system and societal perspective. The cost of providing ASCT (with HDC) for multiple myeloma patients was INR 500,631, while the cost of CC alone was INR 159,775. In the long run, cost per patient per year for ASCT and CC arms was estimated to be INR 119,740 and INR 111,565 respectively. The number of QALYs lived per patient in case of ASCT and HDC alone were found to be 4.1 and 3.5 years respectively.From a societal perspective, ASCT was found to incur an incremental cost of INR 334,433 per QALY gained. If the ASCT is initiated early to patients, the incremental cost for ASCT was found to be INR 180,434 per QALY gained. With current mix of patients, stem cell treatment for multiple myeloma is not cost effective at a threshold of GDP per capita. It becomes marginally cost-effective at 3-times the GDP per capita threshold. However, accounting for the model uncertainties, the probability of ASCT to be cost effective is 59%. Cost effectiveness of ASCT can be improved with early detection and initiation of treatment.

Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

“…Owing to the federal structure of India, and a significantly greater share of public health funding coming from State Governments, states are an essential stakeholder in healthcare decision-making. Some examples of the use of HTA evidence for decision making is seen at the State level (for example, the recent introduction of HPV vaccination in Punjab [77]), however there is no organized system of incorporating such evidence at a broader level [58]. Introduction of the National Health Mission (NHM), under the Ministry of Health and Family Welfare (MoHFW), improved the process of decentralised participatory decision-making.…”

Autologus Stem Cell Transplantation for Cancers: India: 2017

“…CBV and BEAM are standard conditioning regimens for ASCT in lymphoma. Radioimmunotherapy based conditioning regimens are not favoured in various studies [16][17][18][19][20][21][22][23].…”

“…CIBMTR (2001,1999) data shows that patients in second CR have better outcomes and upto 40% of primary refractory patients can be salvaged by ASCT [22].…”

Myeloma at Cross Roads in India

“…Also, resource constraints take a heavy toll on the overall outcomes of the disease [3]. The average cost of therapy per patient in India with and without autologous stem cell transplant (ASCT) from a societal perspective is INR 395,527 (USD 6085) and INR 62,785 (USD 966) respectively [4]. As per the world bone marrow transplant (WBMT) registry we stand last in ASCT rate at 1-137/ 10 million population [5].…”

“…As per the world bone marrow transplant (WBMT) registry we stand last in ASCT rate at 1-137/ 10 million population [5]. In the last 5 years, the access to ASCT has increased with rising number of transplant centers and cost per transplant showing a declining trend [4,6].…”