Potential Therapeutic and Economic Value of Risk-Stratified Treatment as Initial Treatment of Multiple Myeloma in Europe

Abstract

Objectives: Docetaxel and Cabazitaxel are taxane chemotherapy approved in men with mCRPC after they demonstrated improved survival in first and second line respectively. If recent data suggested similar efficacy, these two taxanes have different safety profile and unit price, raising the question of their administration sequence. A cost-utility analysis comparing two sequences of treatment (Cabazitaxel followed by Docetaxel versus Docetaxel followed by Cabazitaxel) for first-line chemotherapy in metastatic prostate cancer was performed in the French context, using data from the CABADOC randomized trial. MethOds: The CABADOC study is a randomized trial with a cross-over design. Patients were randomized to receive either Docetaxel 75mg/m²/q3w x 4 followed by Cabazitaxel 25mg/m²/q3w x 4, or the reverse sequence. The economic analysis included a prospective collection of resources consumed (chemotherapy, hospitalizations, transportation, nurses and consultations) and utility data (using the EQ-5D questionnaire administered before cycle 1, cycle 5 and at the end of chemotherapy) alongside the trial. Costs were evaluated from the French collective perspective and horizon time was limited from the randomization date to the end of 2nd sequence chemotherapy. The ICER was calculated and sensitivity analyses were conducted. Results: From June 2014 to October 2016, 195 patients (median age of 70 years) were randomized in 17 centers. Patients received 3.8 ± 0.7 and 3.2 ± 1.5 cycles of chemotherapy during the first and the second period, respectively. The sequence Docetaxel-Cabazitaxel appears to be more effective (mean QALY per patient of 0.353 ± 0.025 versus 0.328 ± 0.063) and less expensive (mean cost per patient of 17 350 € ± 2955 versus 17 862 € ± 2320) as compared to the sequence Cabazitaxel-Docetaxel. cOnclusiOns: The sequence of treatment with Docetaxel followed by Cabazitaxel appears the optimal one for first line chemotherapy in metastatic prostate cancer from a cost-utility standpoint. NCT: NCT02044354.

Health economic evidence for the use of molecular biomarker tests in hematological malignancies: A systematic review

“…The country of evaluation was mostly from Canada 24,25,33,35 or the US 28,29,31,37 (both n = 4; 29%). Majority of studies were published in a clinical journal ( n = 11; 79%) 24,25,27‐30,32‐36 rather than an economic or HTA journal ( n = 3; 21%) 26,31,37 24‐27,29,33‐35 compared to industry funding ( n = 6; 43%) 28,30‐32,36,37 …”

“…Studies analyzed the impact of molecular biomarker tests across numerous hematological malignancies, including chronic myeloid leukemia (CML) ( n = 6, 43%), 28,31,32,34,36,37 AML ( n = 2; 14%), 25,27 and CLL ( n = 2; 14%) 26,33 . Single studies (each 7%) considered acute lymphoblastic leukemia (ALL), 35 diffuse large B‐cell lymphoma (DLBCL) 29 and multiple myeloma (MM), 30 or both non‐Hodgkin lymphoma (specifically, DLBCL and follicular lymphoma [FL]) and Hodgkin lymphoma 24 24‐26 while other studies used a variety of molecular techniques, such as karyotyping, FISH, qPCR, RT‐qPCR, or gene expression profile test.…”

“…Five (71%) out of seven cost-effectiveness publications suggested cost-effective use of healthcare resources when molecular biomarker tests were used as a companion diagnostic for identifying population groups most likely to respond to treatment. 25,27,29,30,36 Two of these publications evaluated between two diagnostic approaches in AML. One study compared between a multigene targeted genomic analysis and standard molecular analysis in determining optimal consolidation therapies following complete remission from induction chemotherapy for AML, with an ICER of Canadian dollars (CAD) $49 493/QALY gained and a 58% chance of cost-effectiveness at CAD$100 000/QALY.…”

Management of Multiple Myeloma and Usage of Bortezomib: Perspective from India and Ukraine

“…On the basis of most recent published estimates of the average prices in the US, cost of one 21-day cycle of bortezomib was estimated to be $6,450 (3.5 mg vial, quantity 4) or $70,950 per patient (11 cycles) (24). These costs vary as per regimen and further across countries due to variation in pricing agreements and availability of generics (24).…”

“…These costs vary as per regimen and further across countries due to variation in pricing agreements and availability of generics (24). …”