Cost-Effectiveness of Novel Agent Regimens for Transplant-Eligible Newly Diagnosed Multiple Myeloma Patients in India.

Publisher: Open Mind Journals Ltd Country of Publication: New Zealand NLM ID: 101150314 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1179-1896 (Electronic) Linking ISSN: 11755652 NLM ISO Abbreviation: Appl Health Econ Health Policy Subsets: MEDLINE

Original Publication: Auckland, N.Z. : Open Mind Journals Ltd., c2002-

Multiple Myeloma*/drug therapy ; Cost-Benefit Analysis* ; Hematopoietic Stem Cell Transplantation*/economics ; Markov Chains* ; Quality-Adjusted Life Years* ; Bortezomib*/therapeutic use ; Bortezomib*/economics; Humans ; India ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/economics ; Dexamethasone/therapeutic use ; Dexamethasone/economics ; Dexamethasone/administration & dosage ; Male ; Female ; Lenalidomide/therapeutic use ; Middle Aged ; Cyclophosphamide/therapeutic use ; Cyclophosphamide/economics ; Thalidomide/economics ; Thalidomide/therapeutic use ; Thalidomide/analogs & derivatives ; Antineoplastic Agents/economics ; Antineoplastic Agents/therapeutic use ; Antibodies, Monoclonal

Background: Survival outcomes for multiple myeloma have improved dramatically since the introduction of novel therapeutic agents. While these drugs are highly effective in improving survival outcomes and quality of life in patients with multiple myeloma, they come at a significant cost. We assessed the cost-effectiveness of bortezomib-based triplet or quadruplet drug regimens in isolation and followed by autologous hematopoietic stem cell transplantation (AHSCT) for the treatment of newly diagnosed multiple myeloma (NDMM) in the Indian context.
Methods: A Markov model was developed to assess the health and economic outcomes of novel drug regimens with and without AHSCT for the treatment of NDMM in India. We estimated the lifetime quality-adjusted life-years (QALYs) and costs in each scenario. The incremental cost-effectiveness ratios (ICERs) were computed and compared against the current willingness-to-pay threshold of a one-time per capita gross domestic product of ₹146,890 (US$1,927.70) for India. Parameter uncertainty was assessed through Monte Carlo probabilistic sensitivity analysis.
Results: Among seven treatment sequences, the VCd (bortezomib, cyclophosphamide, dexamethasone) alone arm has the lowest cost and health benefits as compared to four treatment sequences, namely VTd (bortezomib, thalidomide, dexamethasone) alone, VRd (bortezomib, lenalidomide, dexamethasone) alone, VRd plus AHSCT and DVRd (Daratumumab, bortezomib, lenalidomide, dexamethasone) plus AHSCT. It was found that VTd plus AHSCT and VCd plus AHSCT arms were extendedly dominated (ED) by combination of two alternative treatments. Among the five non-dominated strategies, VRd has a lowest incremental cost of ₹ 2,20,093 (US$2,888) per QALY gained compared to VTd alone followed by VRd plus AHSCT [₹3,14,530 (US$4,128) per QALY gained] in comparison to VRd alone. None of the novel treatment sequences were found to be cost-effective at the current WTP threshold of ₹1,46,890 (US$1,927.7).
Conclusion: At the current WTP threshold of one-time per capita GDP (₹ 146,890) of India, VRd alone and VRd plus AHSCT has 38.1% and 6.9% probability to be cost-effective, respectively. Reduction in current reimbursement rates of novel drugs, namely VRd, lenalidomide, and pomalidomide plus dexamethasone under national insurance program and societal cost of transplant by 50%, would make VRd plus AHSCT and VTd plus AHSCT cost-effective at an incremental cost of ₹40,671 (US$34) and ₹97,639 (US$1,281) per QALY gained, respectively.
(© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

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F.No. T.11011/02/2017-HR/3100291 Department of Health Research, India

69G8BD63PP (Bortezomib)
7S5I7G3JQL (Dexamethasone)
F0P408N6V4 (Lenalidomide)
4Z63YK6E0E (daratumumab)
8N3DW7272P (Cyclophosphamide)
4Z8R6ORS6L (Thalidomide)
0 (Antineoplastic Agents)
0 (Antibodies, Monoclonal)

Date Created: 20240306 Date Completed: 20240614 Latest Revision: 20240701

20240702

10.1007/s40258-024-00877-1

38448720