Cost-Effectiveness of Carfilzomib, Ixazomib, Elotuzumab, or Daratumumab with Lenalidomide and Dexamethasone versus Lenalidomide and Dexamethasone in RRMM
Lenalidomide-based triplet combinations have become a standard of care in the treatment of relapsed/refractory multiple myeloma (RRMM). Carfilzomib, ixazomib, elotuzumab (ELO), or daratumumab (DAR) in triplet combination with lenalidomide (LEN) plus dexamethasone (DEX) have all shown superior efficacy over just LEN+DEX in patients with RRMM. This study examines the comparative efficacy and cost-effectiveness of these agents.
Efficacy as measured by progression-free survival (PFS) was indirectly estimated through a network meta-analysis and Bücher method of indirect comparison. Incremental cost-effectiveness and cost-utility ratios were calculated for PFS life-years (LYs) and quality-adjusted life-years (QALYs) gained in base-case and probabilistic sensitivity analyses. Inputs that were assessed included cost of chemotherapy, administration, adverse-event management, disease monitoring, utilities for health states, and disutilities for adverse events.
The PFS hazard ratios were similar across all the agents studied. The network analysis and indirect comparison showed the superiority of DAR+LEN+DEX over other triplet therapies in terms of PFS. The cost-effectiveness analysis indicated that all 4 triplet regimens were associated with additional PFS LYs and QALYs gained over LEN+DEX, but at an additional cost. DAR+LEN+DEX was associated with the greatest number of PFS LYs and QALYs gained at the lowest relative cost.
The superior PFS efficacy of DAR+LEN+DEX is associated with positive cost-effectiveness and cost-utility in patients with RRMM. In terms of limitations, it should be noted that the network analysis in this study was limited to 1 clinical trial per triplet regimen.
Alsaid N, et al. ASCO Abstract 8030.