Daratumumab vs pomalidomide for the treatment of relapsed/refractory multiple myeloma: A cost‐effectiveness analysis

Gong, Chen; Studdert, Ann L; Liedtke, Michaela

doi:10.1002/ajh.25372

Cited by 6 publications

(30 citation statements)

References 5 publications

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“…Pelligra et al reported that PomDex may be a cost‐effective treatment option relative to daratumumab or carfilzomib monotherapy in patients that were heavily pretreated with RRMM . On the contrary, Gong et al have presented different results, showing that daratumumab is costeffective for RRMM as compared to pomalidomide …”

Section: Introductionmentioning

confidence: 99%

Pomalidomide, cyclophosphamide, and dexamethasone for elderly patients with relapsed and refractory multiple myeloma: A study of the Korean Multiple Myeloma Working Party (KMMWP‐164 study)

et al. 2020

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Patients with transplant‐ineligible relapsed and refractory multiple myeloma (RRMM) have a short life expectancy, especially when they have failed both the proteasome inhibitor and immunomodulator therapies. This study aimed to assess the efficacy and safety of pomalidomide, cyclophosphamide, and dexamethasone (PCd) in elderly patients with RRMM. This phase 2 clinical trial recruited 55 elderly patients with RRMM. The patients underwent a 28‐day treatment cycle: pomalidomide (4 mg/day on days 1‐21, administered orally) and cyclophosphamide (400 mg/day on days 1, 8, and 15; administered orally) plus dexamethasone. The median (range) age of the patients was 73.3 (64‐86) years, and 8 (14.5%) patients who were ≥ 80 years old. Eight (14.5%) and 31 (56.4%) patients exhibited stage III (revised international staging system) and frail status (simplified frailty scale), respectively. The overall response rate (ORR) and clinical benefit rate (CBR) of PCd therapy were 58.2% and 72.7%, respectively. The median PFS and median overall survival (OS) were 6.90 months (95% CI, 4.7‐9.0) and 18.48 months (95% CI, 9.4‐27.6), respectively. The incidence rate of grade ≥ 3 non‐hematological toxicities was 70.8%. In particular, the incidence rate of primary infection was 45.4%, including 21.8% for pneumonia, 9.0% for sepsis, and 14.6% for febrile neutropenia. In conclusion, PCd is an effective regimen for elderly patients with RRMM who had failed both bortezomib and lenalidomide treatments, but in whom the treatment‐associated infection is the main cause of morbidity and mortality.

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Section: Introductionmentioning

confidence: 99%

Pomalidomide, cyclophosphamide, and dexamethasone for elderly patients with relapsed and refractory multiple myeloma: A study of the Korean Multiple Myeloma Working Party (KMMWP‐164 study)

et al. 2020

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“…They concluded that the daratumumab-based regimens for second-and third-line RRMM may provide clinical benefits by prolonging PFS and OS and improving quality of life, but the price of daratumumab need to be reduced to benefit more patients. In the heavily pretreated RRMM patients, Pelligra et al and Gong CL et al (Pelligra et al, 2017;Gong et al, 2019) came to different conclusions. Gong CL et al reported that the ICER of daratumumab gained vs pomalidomide was $156,385 per QALY, but Pelligra et al reported that the QALYs of daratumumab gained was lower than pomalidomide but the costs higher than its.…”

Section: Discussionmentioning

confidence: 98%

“…There was no utilities data for daratumumab-based regimens to treat TNE NDMM. We summarized utilities related to daratumumab-based regimens in several studies for relapsed or refractory multiple myeloma (RRMM) (Pelligra et al, 2017;Zhang et al, 2018;Gong et al, 2019), and combined the mean first-line utility of MM to estimate the utility of D-VMP group. For the utility of progression disease, we assumed the same value (Usmani et al, 2016; Table 1).…”

Section: Utility Estimatesmentioning

confidence: 99%

Cost-Effectiveness Analysis of Adding Daratumumab to Bortezomib, Melphalan, and Prednisone for Untreated Multiple Myeloma

et al. 2021

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Background: To evaluate the cost-effectiveness of adding daratumumab to bortezomib, melphalan, and prednisone for transplant-ineligible newly diagnosed multiple myeloma patients.Methods: A three-state Markov model was developed from the perspective of US payers to simulate the disease development of patient’s life time for daratumumab plus bortezomib, melphalan, and prednisone (D-VMP) and bortezomib, melphalan, and prednisone (VMP) regimens. The primary outputs were total costs, expected life-years (LYs), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).Results: The base case results showed that adding daratumumab to VMP provided an additional 3.00 Lys or 2.03 QALYs, at a cost of $262,526 per LY or $388,364 per QALY. Sensitivity analysis indicated that the results were most sensitive to utility of progression disease of D-VMP regimens, but no matter how these parameters changed, ICERs remained higher than $150,000 per QALY.Conclusion: In the case that the upper limit of willingness to pay threshold was $150,000 per QALY from the perspective of US payers, D-VMP was not a cost-effective regimen compared to VMP.

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“…The ICER for second-line regimens ranged from about $51,000/QALY to >$450,000/QALY; in the third line, the ICER ranged from over $60,000/QALY to over $500,000/QALY [36]. Other US-based CEAs in previously treated MM found ICERs from about $156,000/ QALY for daratumumab monotherapy vs pomalidomide [37] to >$1,300,000/QALY when comparing DRd to Rd [38]. Thus, the ICER identified in this study for XVd, while high, reflects the high drug costs seen in most novel oncology regimens.…”

Section: Summary Of Model Findingsmentioning

confidence: 98%

Cost Effectiveness of Triplet Selinexor-Bortezomib-Dexamethasone (XVd) in Previously Treated Multiple Myeloma (MM) Based on Results from the Phase III BOSTON Trial

Dolph¹,

Tremblay²,

Leong

2021

PharmacoEconomics

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Background and Objective Nearly all patients with multiple myeloma undergo multiple rounds of therapy. The phase III BOSTON trial of once-weekly selinexor and once-weekly bortezomib with dexamethasone (XVd) vs twice-weekly bortezomib and dexamethasone (Vd) is the basis for this cost-effectiveness analysis in previously treated multiple myeloma from a US commercial payer perspective over a lifetime horizon. Methods A partitioned survival model enabled use of direct overall survival and progression-free survival curves from BOSTON to generate four health states for XVd and Vd: progression-free survival on treatment, progression-free survival off treatment, post-progression, and mortality. Using a 1-week cycle length, benefits and costs were discounted at 3.0% annually. Additional comparators were included in an exploratory analysis that compared XVd against seven additional regimens (six triplets, one doublet). Results After considering costs, utility, progression, and survival, the base-case incremental cost-effectiveness ratio of XVd vs Vd was $475,430/quality-adjusted life-year (QALY). The 50% cost-effectiveness probability midpoint was near $470,000/QALY, based on a probabilistic sensitivity analysis. The robustness of the analysis was supported by additional scenario assessment and deterministic and probabilistic sensitivity analyses, which generally demonstrated little variance, with greatest sensitivity to variations in discount rates and utility values. In an exploratory analysis against external comparators, XVd showed a higher QALY gain with a lower cost (i.e., dominance) compared with lenalidomide/dexamethasone (Rd), pomalidomide/bortezomib/dexamethasone (PVd), and carfilzomib/pomalidomide/dexamethasone (KPd). Conclusions Addition of XVd to the previously treated multiple myeloma treatment landscape provides a novel oral treatment option, which, when compared to Vd in the base-case analysis resulted in an incremental cost-effectiveness ratio of $475,430/ QALY. Exploratory analyses comparing against external comparators suggest that XVd was dominant vs Rd, PVd, and KPd. Plain Language SummaryPatients with multiple myeloma often relapse and require multiple treatments to extend survival while maintaining quality of life. Many of the standard treatment regimens include twice-weekly bortezomib, which is associated with potentially severe peripheral neuropathy. The novel triplet regimen of once-weekly selinexor and once-weekly bortezomib with dexamethasone (XVd) improves cancer response and progression-free survival while decreasing the rate of peripheral neuropathy. This study used economic modeling to calculate the cost of the triplet XVd regimen per life-year gained and per quality-adjusted life-year gained. XVd had a lower cost with a higher quality-adjusted life-year benefit compared with lenalidomide/dexamethasone, pomalidomide/bortezomib/dexamethasone, and carfilzomib/pomalidomide/dexamethasone in previously treated multiple myeloma.

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Daratumumab vs pomalidomide for the treatment of relapsed/refractory multiple myeloma: A cost‐effectiveness analysis

Cited by 6 publications

References 5 publications

Pomalidomide, cyclophosphamide, and dexamethasone for elderly patients with relapsed and refractory multiple myeloma: A study of the Korean Multiple Myeloma Working Party (KMMWP‐164 study)

Pomalidomide, cyclophosphamide, and dexamethasone for elderly patients with relapsed and refractory multiple myeloma: A study of the Korean Multiple Myeloma Working Party (KMMWP‐164 study)

Cost-Effectiveness Analysis of Adding Daratumumab to Bortezomib, Melphalan, and Prednisone for Untreated Multiple Myeloma

Cost Effectiveness of Triplet Selinexor-Bortezomib-Dexamethasone (XVd) in Previously Treated Multiple Myeloma (MM) Based on Results from the Phase III BOSTON Trial

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