Lenalidomide for multiple myeloma: cost-effectiveness in patients with one prior therapy in England and Wales

Brown, Ruth E.; Stern, Sean; Dhanasiri, Sujith; Schey, Stephen

doi:10.1007/s10198-012-0395-6

Cited by 28 publications

(24 citation statements)

References 17 publications

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“…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 …”

Section: Resultsmentioning

confidence: 99%

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

2016

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Summary What is known and objective Given the increasing healthcare costs and the recent introduction of novel agents in the treatment for multiple myeloma (MM), an incurable haematologic malignancy, more efficient use of existing resources is fundamental. The objective of this study was to systematically review economic evaluations of the use of novel agents in MM and assess their reporting quality. Methods A literature search was performed in PubMed/Medline, Latin American and Caribbean Health Sciences Literature, Cost‐Effectiveness Analysis Registry and the National Health Services Economic Evaluation Database for economic evaluations up to June 2015. The search strategy included Medical Subject Headings terms or text words related to MM, economic evaluations and drugs. Full economic evaluations of bortezomib, thalidomide or lenalidomide in patients with MM that were published in English, Portuguese or Spanish were included. Two independent authors performed study selection, data extraction and quality assessment using 24 items from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results and discussion Of the 132 potentially relevant records identified, eight satisfied the inclusion criteria. Most studies were cost‐effectiveness analyses combined with cost‐utility analyses (n = 6) from the public payer perspective (n = 4) and were performed in Europe (n = 6) on patients with refractory or relapsed MM (n = 5). All studies were based on economic models, with four of them using discrete event simulation. We found bortezomib‐based therapies to be one of the more commonly selected treatment strategies for comparison (n = 7). Overall, the intervention was more effective and costlier than the alternative strategy (average of $54 630 per life year; $68 261 per quality‐adjusted life year–QALY). The CHEERS’ total score was 14·6 (SD = 2·6) with the most frequent problems being the lack of precision measures for all model parameters, no evaluation of heterogeneity of the results by subgroup analyses and no description of the role the funder in the identification, design, conduct and reporting of the analysis. What is new and conclusion Most analyses of the novel therapeutic agents determined that they were cost‐effective in MM at a threshold of up to $100 000/QALY. Nevertheless, the poor reporting quality of the economic studies requires improvement to ensure greater transparency.

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Section: Resultsmentioning

confidence: 99%

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

2016

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“…However, according to recent evidence, combination therapy with lenalidomide–dexamethasone may be a cost-effective option for the treatment of patients with rrMM in several European countries and settings 16,36,37. Concerning Greece, to the best of our knowledge, this is the first pharmacoeconomic study undertaken to compare these two agents.…”

Section: Discussionmentioning

confidence: 99%

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

Fragoulakis¹,

Kastritis²,

Ψαλτοπούλου³

et al. 2013

CMAR

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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.

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“…Clinical trials demonstrated that lenalidomide, for example, increased expected QALYs from 1.5 to 3.7 for patients requiring second-line treatment. (16)…”

Section: Multiple Myeloma Case Studymentioning

confidence: 99%

“…In 2004, patients requiring second-line therapies often used dexamethasone or a combination of thalidomide and dexamethasone as a second-line treatment. (16) Once lenalidomide and bortezomib came onto the market, however, almost all non-responders received one of these therapies within a few years. By 2009, 67% of all multiple myeloma prescriptions written were for drug regimens using lenalidomide or bortezomib.…”

Section: Multiple Myeloma Case Studymentioning

confidence: 99%

Quality-Adjusted Cost Of Care: A Meaningful Way To Measure Growth In Innovation Cost Versus The Value Of Health Gains

Lakdawalla

Shafrin²,

Lucarelli

et al. 2015

Health Affairs

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Technology drives both health care spending and health improvement. Yet, policymakers rarely see measures of cost growth that account for both effects. To fill this gap, we present the “quality-adjusted cost of care” (QACC), illustrating cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We apply QACC to two cases. For colorectal cancer, drug cost per patient increased by $35,000 between 1998 and 2005 due to new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in QACC. For multiple myeloma, new therapies increased cost by $72,900 between 2004 and 2009 but offsetting health benefits lowered overall QACC by $67,900. However, myeloma patients on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but with starkly different implications for whether society “got what it paid for.”

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Lenalidomide for multiple myeloma: cost-effectiveness in patients with one prior therapy in England and Wales

Abstract: LEN/DEX is a cost effective oncology therapy from the perspective of the NHS for MM patients with one prior treatment.

Cited by 28 publications

References 17 publications

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

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

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

Quality-Adjusted Cost Of Care: A Meaningful Way To Measure Growth In Innovation Cost Versus The Value Of Health Gains

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