PCN222 CARFILZOMIB/LENALIDOMIDE/DEXAMETHASONE IN THE SECOND-LINE SETTING FOLLOWED BY DARATUMUMAB/LENALIDOMIDE/DEXAMETHASONE IN THE THIRD-LINE SETTING VERSUS THE OPPOSITE TREATMENT SEQUENCE: A COST COMPARISON STUDY FROM A BRAZILIAN PRIVATE HEALTH CARE PERSPECTIVE

Abstract

The aim of this study is to estimate and compare the costs associated with two treatment sequences in relapsed/refractory multiple myeloma (RRMM): carfilzomib/lenalidomide/dexamethasone (KRd) in the second-line setting followed by daratumumab/lenalidomide/dexamethasone (DRd) in the third-line setting (‘KRd-DRd sequence’) versus the opposite treatment sequence. A health economic model was developed to estimate and compare drug acquisition costs for the two treatment sequences from a Brazilian private health care perspective. It was assumed that patients discontinue treatment and switch to the subsequent treatment upon progression. Clinical input data (i.e., progression-free survival by line) were derived from published pivotal trials. Drug acquisition costs were estimated considering therapy-specific dosing schedules. Brazilian list prices from April 2019 were used. The model estimated total costs and cost per month of PFS over a three-year analysis horizon. The impact of vial sharing was explored. When no vial sharing was assumed, total drug acquisition costs were estimated to be BRL 1,608,885 for the KRd-DRd sequence and BRL 1,884,690 [+17%] for the DRd-KRd sequence. The KRd-DRd sequence had a lower cost per month of PFS than the DRd-KRd sequence (BRL 48,210 vs. BRL 54,857 [+14%], respectively). Similarly, estimated costs were lower for the KRd-DRd sequence than for the DRd-KRd sequence when vial sharing was assumed (total cost: BRL 1,454,570 vs. BRL 1,785,448 [+23%]; cost per month of PFS: BRL 43.586 vs. BRL 51.968 [+19%]). The results of the modeling analysis suggest that the KRd-DRd sequence yields lower drug acquisition costs than the DRd-KRd sequence therefore, from the Brazilian private healthcare perspective, starting treatment with KRd may result in cost savings. The results are associated with some inherent uncertainty due to differences in trial populations, trial design (fixed duration for carfilzomib vs. treatment till progression for daratumumab) and because treatment duration is typically shorter than PFS.