Clinical and Economic Study of Daratumumab in Combination Therapy for Previously Treated Patients with Multiple Myeloma

Abstract

Application of “novel agents” for treatment of relapsing and/or refractory multiple myeloma (r/r MM) in lenalidomide-based schemes: daratumumab (DRd), carfilzomib (KRd), ixazomib (IRd) or elutuzumab (ERd) can improve treatment outcomes for patients compared with standard therapy with lenalidomide and dexamethasone (Rd). Access to lenalidomide is generally provided for Russian citizens in the framework of the federal high-cost nosologies program. But expenses for “novel agents” for patients with r/r MM are covered by local regional healthcare systems. The aim of this work was to conduct a clinical and economical study of “novel agents” in lenalidomide-based schemes from the perspective of regional healthcare systems of Russian Federation. Material and Methods. Based on data from randomized clinical trials of “novel agents” and our own indirect comparison of considered alternatives we proposed a Markov model for progression of r/r MM. In the model, we compared DRd, KRd, IRd, ERd and Rd schemes by calculating average number of life years without progression and direct medical costs from the perspective of regional healthcare systems per 1 patient over 5-year period. Based on the obtained data we conducted cost-effectiveness analysis and estimated cost of an incremental year of life without progression when using “novel agents” vs Rd combination, as well as for DRd scheme vs each of the other “novel agents”. Results. Cost of an incremental year of life without progression for DRd scheme vs Rd scheme was 10,402,613 rub., which is 11.5-62.2% lower than for other “novel agents” vs Rd. Cost of an incremental life year without progression for DRd scheme vs IRd scheme was 72.4% lower than for IRd vs Rd. The same ratio for DRd vs KRd was 22.4% lower than for KRd vs Rd. Cost of an incremental life year without progression for DRd scheme vs ERd scheme was not identified because DRd scheme was both less costly and more effective than ERd. Conclusions. Treatment of r/r MM with DRd scheme is more cost-effective compared with IRd and KRd schemes, and less costly and more effective than ERd scheme.