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February 15, 2019

Study Examines Cost-Effectiveness in Multiple Myeloma Treatments

Kaitlynn Ely
New drugs to treat multiple myeloma (MM) have provided clinical benefits, but a study published in the Journal of Managed Care & Specialty Pharmacy found not all of them can be considered cost effective.
New drugs to treat multiple myeloma (MM) have provided clinical benefits, but a study published in the Journal of Managed Care & Specialty Pharmacy found not all of them can be considered cost effective.

Historically, 2 drugs—bortezomib (BOR) and lenalidomide (LEN)—have been used in combination with dexamethasone (DEX) to treat MM. However, 5-year survival rates remain below 50% with a single course of drug therapy costing between $75,000 and $250,000. There has not been an evaluative of the cost effectiveness of other drugs used to treat following relapse, including pomalidomide (POM), carfilzomib (CFZ), ixazomib (IX), daratumumab (DAR), elotuzumab (ELO), and panobinostat (PAN).

"The availability of effective treatment options for MM patients is of paramount importance," the authors wrote. "However, in an era of continuing increases in healthcare spending and drug prices, it is also important to understand the relationship between costs and outcomes achieved."

The study assessed the relationship between clinical outcome and monetary price of 8 regimens used to treat patients who have relapsed. A 3-state partition survival model was developed to categorize patients into progression-free survival (PFS) state, progressed disease with subsequent treatments, and death. Evidence on treatment methods was collected through a Bayesian network meta-analysis while using LEN+DEX as a baseline treatment.

The overall survival (OS) rates in relation to PFS were used to analyze the effectiveness of the treatment. Calculating total estimated treatment cost was done by applying drug unit costs to the utilization estimates. Drug costs were derived from the Final 2016 Medicare Coding & Payment for Drug Administration Services.

The results show that out of the 8 possible regimens within the cost-effective range, only 2 are considered to be value-based treatments. DAR-BOR-DEX is the most recommended treatment due to PAN-BOR-DEX’s high levels of toxicity. The treatments with the most uncertainty include ELO+LEN+DEX and IX+LEN+DEX. While there has been major advancement in treating MM during relapse, these advancements have not been done in a cost-effective way. It is almost impossible to offer discounts to patients due to the high price of inputs going into treatments.

“The introduction of newer drugs and regimens to treat second- and third-line relapsed and/or refractory MM appears to provide clinical benefits by lengthening PFS and OS and improving quality of life,” the authors concluded. “However, only the addition of DAR or PAN may be considered cost-effective options according to commonly cited thresholds, and PAN+BOR+DEX results require cautious interpretation. Achieving levels of value more closely aligned with patient benefit would require substantial discounts for the remaining agents evaluated.”

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