Daratumumab Utilization and Cost Analysis among Patients with Multiple Myeloma in a US Community Oncology Setting

Abstract

Background: The introduction of daratumumab into the treatment of multiple myeloma has improved outcomes in patients; however, community oncologists often dose more frequently than the US FDA-approved label. Materials and methods: Integra analyzed its database to elucidate daratumumab treatment patterns and the impact of increased utilization on the cost of care for multiple myeloma. Results: Following week 24, 671 (65%) of 1037 patients remained on daratumumab-containing regimens, with 330 patients continuing more frequent treatments than the expected once-every-4-weeks dosing described in the standard dosing schedule. Patients received an average of 14% more daratumumab doses than the FDA-approved label indicates, increasing the 1-year daratumumab costs by an estimated US$31,353. Conclusion: Daratumumab is utilized more frequently than the FDA-recommended dosing, leading to higher multiple myeloma treatment costs.

Real-world Duration of Use and Dosing Frequency of Daratumumab in Patients With Multiple Myeloma in the United States

“…The analysis did not consider patient attrition over time, possibly leading to an overestimate in adherence. 7 However, we show that duration of therapy for DARA-based regimens in the real-world is relatively long and adherence is high. Although our study was not designed to evaluate the effect of duration of therapy on efficacy, we interpret these results favorably, as it has been previously shown that continuous therapy and longer durations of treatment are associated with improved patient outcomes, including better tolerability and longer survival.…”

“…Previous studies have evaluated real-world use of DARA in the United States and reported that the median duration of treatment across LOTs (with various combinations) was 9.8 months, 7 which is slightly longer compared with a median of 6.5 months reported by another group (with ranges from 4.1 to 8.8 months, depending on the LOT). 6 These studies do not follow DARA continuously.…”

“…Moreover, our data show high fidelity to the label, which indicates patients were not receiving more frequent dosing than expected. A recent analysis by Gordan et al 7 reported a higher DARA adherence ratio of 1.19; however, their analysis projected an adherence ratio for a 12-month period using data with a mean treatment duration of only 5.6 months (median, 9.8 months). The analysis did not consider patient attrition over time, possibly leading to an overestimate in adherence.…”

“…5 To this end, patients initiating DARA may continue DARA use, even as other agents in the regimen and LOTs change. Duration of DARA treatment has been analyzed previously for each LOT 6 , 7 ; however, there is a lack of information on the continuous use of DARA and its dosing frequency across multiple regimens or LOTs. This study examines the continuous duration of DARA treatment and the dosing frequency of DARA across multiple LOTs using real-world data from patients with MM in the United States.…”

Safety and Efficacy of Subcutaneous Daratumumab in Systemic AL Amyloidosis

“…36 Estimated total cost of administering IV daratumumab over 52 weeks, with 23 expected infusions, is US $167,826. 37 For context, the mean cost of cyclophosphamide per 100mg infusion in 2023 US dollars is $17.942, for an estimated total cost per 6 regimen cycles at dosing 300mg/m 2 in the average 1.91m 2 individual of $1,291.82. 38 The mean cost of bortezomib per 0.1mg injection in 2023 US dollars is $2.289, for an estimated total cost per 6 regimen cycles at dosing 1.3mg/m 2 in the average 1.91m 2 individual of $1364.06.…”