Abstract
To assess the cost-effectiveness of daratumumab combined with dexamethasone and either the immunomodulatory drug (IMiD) lenalidomide (Rd) or the proteasome inhibitor (PI) bortezomib, relative to Rd. An economic model considering 3 health states (progression-free [PF], post-progression [PP], and death) estimated costs, life years (LYs), and quality-adjusted LYs (QALYs) over a lifetime. PFS data from the Rd arms of MM-009/010 were fitted to a parametric function and adjusted for the study effect of MM-009/010 vs. POLLUX, using a matching-adjusted indirect comparison (MAIC). The relative efficacy for DRd and DVd (vs Rd) were derived from an MAIC including POLLUX and CASTOR: DRd PFS hazard ratio [HR] = 0.37 (95% confidence interval [CI]: 0.27, 0.51); DVd HR = 0.98 (95% CI: 0.61, 1.57). PP survival was predicted based on data from MM-009/010. Health state utilities were obtained from published literature. Costs (2017 USD) included drug acquisition (PF and PP states), adverse event management, and monitoring; these were obtained from public and private data sources. Health and cost outcomes were discounted at 3% per year. DRd was predicted to have substantially longer LYs and QALYs (8.03 and 6.24, respectively) than Rd (5.16 and 3.84); however, LYs and QALYs for DVd (5.21 and 3.86) were similar to those of Rd. Incremental costs were about $635,000 for DRd and $22,000 for DVd, relative to Rd. These resulted in incremental cost-effectiveness ratios (relative to Rd) of approximately $265,000 and $1,379,000 per QALY for DRd and DVd, respectively. The analysis suggests that Rd remains the most cost-effective treatment for patients with RRMM. When considering the $109,000-$297,000 per QALY gained threshold reported by Braithwaite et al. (Med Care, 2008), the use of daratumumab with lenalidomide would also be a cost effective option for patients with RRMM compared to daratumumab with the PI, bortezomib.
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