Economic evaluation of therapies for patients suffering from relapsed-refractory multiple myeloma in Greece

Abstract

BackgroundMultiple myeloma is a hematologic malignancy that incurs a substantial economic burden in care management. Since most patients with multiple myeloma eventually relapse or become refractory to current therapies (rrMM), the aim of this study was to assess the cost-effectiveness of the combination of lenalidomide–dexamethasone, relative to bortezomib alone, in patients suffering from rrMM in Greece.MethodsAn international discrete event simulation model was locally adapted to estimate differences in overall survival and treatment costs associated with the two alternative treatment options. The efficacy data utilized came from three international trials (MM-009, MM-010, APEX). Quality of life data were extracted from the published literature. Data on resource use and prices came from relevant local sources and referred to 2012. The perspective of the analysis was that of public providers. Total costs for monitoring and administration of therapy to patients, management of adverse events, and cost of medication were captured. A 3.5% discount rate was used for costs and health outcomes. A Monte Carlo simulation was used to estimate probabilistic results with 95% uncertainty intervals (UI) and a cost-effectiveness acceptability curve.ResultsThe mean number of quality-adjusted life years (QALYs) was 3.01 (95% UI 2.81–3.20) and 2.22 (95% UI 2.02–2.41) for lenalidomide–dexamethasone and bortezomib, respectively, giving an incremental gain of 0.79 (95% UI 0.49–1.06) QALYs in favor of lenalidomide–dexamethasone. The mean cost of therapy per patient was estimated at €80;77,670 (95% UI €80;76,509–€80;78,900) and €80;48,928 (95% UI €80;48,300–€80;49,556) for lenalidomide–dexamethasone and bortezomib, respectively. The incremental cost per life year gained with lenalidomide–dexamethasone was estimated at €80;29,415 (95% UI €80;23,484–€80;37,583) and the incremental cost per QALY gained at €80;38,268 (95% UI €80;27,001–€80;58,065). The probability of lenalidomide–dexamethasone being a cost-effective therapy option at a threshold three times the per capita income (€80;60,000 per QALY) was higher than 95%. The results remained constant, without altering the conclusions, under several hypothetical scenarios.ConclusionThe combination of lenalidomide and dexamethasone may represent a cost-effective choice relative to bortezomib monotherapy for patients in Greece with previously treated multiple myeloma.

Systematic review of the economic evaluations of novel therapeutic agents in multiple myeloma: what is the reporting quality?

“…Among the selected studies, the results were most sensitive to the cost of the novel agents ( n = 6) and the hazard ratios for overall survival ( n = 3) . Only half of these economic studies considered the variation in utility values when conducting deterministic sensitivity analyses. Indeed, the results from one of the studies were sensitive to this factor …”

“…After reviewing the titles and abstracts, 16 articles were selected for full-text examination. Of these, eight economic studies [14][15][16][17][18][19][20][21] fully met the eligibility criteria and were included in this systematic review. Excluded studies and reasons for their exclusion are detailed in Appendix S2.…”

“…Bortezomib plus melphalan and prednisone versus melphalan and prednisone plus thalidomide, and bortezomib plus melphalan and prednisone versus melphalan and prednisone plus lenalidomide with lenalidomide maintenance were reported by Garrison et al 19 Although bortezomib was found to be dominant compared with lenalidomide plus dexamethasone in one study of patients with relapsed/refractory MM, 15 this drug was less costly and less effective in two other economic evaluations assessing the same population. 16,20 However, it is worth noting that the three analyses were not based on head-to-head comparisons.…”

“…Most studies performed both probabilistic and deterministic sensitivity analyses (n = 5) to assess the robustness of model outcomes against parameter uncertainty and/or model assumptions. Among the selected studies, the results were most sensitive to the cost of the novel agents (n = 6) [14][15][16][17][18]20 and the hazard ratios for overall survival (n = 3). [17][18][19] Only half of these economic studies 15,17,18,20 Full-text articles assessed for eligibility (n = 16)…”

A costing study of bortezomib shows equivalence of its real‐world costs to conventional treatment

“…It found higher costs with bortezomib compared to thalidomide (Gaultney et al ., ). Conversely, several convenience‐sample studies (Richardson et al ., ; Yoong et al ., ; Picot et al ., ; Delforge et al ., ; Durie et al ., ; Garrison et al ., ; Teitelbaum et al ., ; Fragoulakis et al ., ,) suggested bortezomib cost effectiveness was similar to thalidomide and, in some cases, superior to lenalidomide. None of these studies reflected a real‐world, patient‐based cohort and all were limited by trial settings, significant pharmaceutical company involvement, small sample size or limited data presentation.…”