Analysis of the cost-effectiveness of three-component therapies with daratumumab for the treatment of patients with recurrent refractory multiple myeloma

Abstract

Multiple myeloma (MM) is a debilitating malignancy. It is a B-cell neoplasia affecting immunoglobulin-producing plasma cells and is the second most common hematological malignancy. The aim of the study is to model local data on long-term costs and health benefits of alternative health technologies for the treatment of patients with recurrent or refractory multiple myeloma (RRMM) and to implement an indirect comparison based on network meta-analysis. Data on future health benefits and costs after the end of the POLLUX and CASTOR clinical trials were modeled using a Markov model with two health states and one absorbing state. The model includes all possible health states that reflect the course of the disease and provides all the probabilities of transition from one health state to another. Input data in the model are the primary and secondary endpoints in randomized multicenter trials identified and measured as progression-free survival, time to disease progression, very good partial response, minimal residual disease, overall survival, and response duration. The time horizon of the model is lifelong. Costs and benefits are discounted at 3.5% per annum. The chosen perspective is the point of view of the third party payer. The modeling was performed using the Tree Age Pro Healthcare software product. A cost-effectiveness analysis and indirect comparison was performed based on a network meta-analysis of alternative health technologies designed to treat patients with RRMM. The incremental ratio of additional costs and additional health benefits for the studied alternative therapies were calculated. Deterministic and probabilistic sensitivity analysis were used to assess safety. The results show that the three-component therapy daratumumab/lenalidomide/dexamethasone is not a cost-effective therapy compared to lenalidomide/dexamethasone and daratumumab/bortezomib/dexamethasone for the treatment of patients with RRMM due to the high cost of a therapeutic course. The value of the cost-benefit ratio of daratumumab/lenalidomide/dexamethasone compared to therapeutic alternatives significantly exceeds the cost-effectiveness threshold, which is ICER ≤ BGN 50,000/QALY. In order to reach the cost-effectiveness threshold, the marketing authorization holder of daratumumab needs to reduce its price by at least 6.25% in the negotiation process with the payer.