Abstract
Background: This study aimed to evaluate the cost-effectiveness of treating transplant-ineligible myeloma patients with either a bortezomib plus thalidomide plus dexamethasone (VTD) or a bortezomib plus melphalan plus prednisolone (VMP) treatment in Taiwan. Methods: Newly diagnosed, transplant-ineligible myeloma patients with VTD or VMP therapy were enrolled from two medical centers in southern Taiwan. Quality-adjusted life years (QALYs) were used as the measurement unit of the effectiveness evaluation, and the incremental cost-effectiveness ratio (ICER) was used for comparison between the two groups. A net monetary benefit approach and cost-effectiveness acceptability curve were also used for the cost-effectiveness assessment. A one-way sensitivity analysis was used to check the impact of different parameters. In total, 77 patients were enrolled in the study with 43 patients in the VTD group and 34 patients in the VMP group. Clinical presentations were similar without significant difference, except the VTD group had a higher survival rate (p = 0.029). Comparisons of the two groups over an eight-month time horizon revealed a significant lower mean of direct medical costs in the VTD group than in the VMP group (p < 0.001), and a significantly higher average QALY was gained (p < 0.001). Conclusions: The study demonstrated the greater clinical benefit and cost-effectiveness of VTD compared to VMP therapy in transplant-ineligible, newly diagnosed myeloma patients.
Highlights
Multiple myeloma (MM) is a malignant B-cell disorder arising from plasma cells and accumulating in the bone marrow; it is the second most common hematological malignancy, accounting for 13% of all hematologic malignancies and 1% of all cancers in the world [1,2,3]
The aim of this study was to assess the cost-effectiveness of either the VTD or VMP treatment over a period of eight months for newly diagnosed myeloma patients who were ineligible for transplant
This is the first cost-effectiveness assessment on newly diagnosed myeloma patients who were transplant-ineligible with VTD and VMP therapy
Summary
Multiple myeloma (MM) is a malignant B-cell disorder arising from plasma cells and accumulating in the bone marrow; it is the second most common hematological malignancy, accounting for 13% of all hematologic malignancies and 1% of all cancers in the world [1,2,3]. The availability of novel agents currently used by hematologists and oncologists, including proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies has improved the outcomes of newly diagnosed and relapsed/refractory MM patients significantly. These innovative agents/therapies have resulted in increased costs and economic burdens to healthcare providers [8,9,10,11]. This study aimed to evaluate the cost-effectiveness of treating transplantineligible myeloma patients with either a bortezomib plus thalidomide plus dexamethasone (VTD). Methods: Newly diagnosed, transplant-ineligible myeloma patients with VTD or VMP therapy were enrolled from two medical centers in southern Taiwan. 77 patients were enrolled in the study with 43 patients in the VTD group and 34 patients in the VMP group
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