Despite Clinical Efficacy, Only Certain Myeloma Treatments Are Cost-Effective

The addition of Darzalex (daratumumab) and Farydak (panobinostat) appeared to be the most cost-effective regimen to treat multiple myeloma, according to a recent analysis published in the Journal of Managed Care & Specialty Pharmacy.

Over the past few years, the Food and Drug Administration (FDA) has approved a variety of triplet combinations for the treatment of patients with multiple myeloma. However, little is known which regimens have the best economic impact, without sacrificing clinical outcomes that is.

“The increasing cost of U.S. health care, and specifically for cancer, has generated renewed discussion about the value of medical technologies,” the researchers wrote. “The availability of effective treatment options for multiple myeloma patients is of paramount importance. However, in an era of continuing increases in health care spending and drug prices, it is also important to understand the relationship between costs and outcomes achieved.”

The study — conducted by researchers from the University of Washington in Seattle and from the Institute for Clinical and Economic Review in Boston – evaluated the cost-effectiveness of treatments for relapsed and/or refractory multiple myeloma using a partition survival model that they had developed.

The model included three health states — progression-free survival (PFS), disease progression and death – to help compare Kyprolis (carfilzomib), Empliciti (elotuzumab), Ninlaro (ixazomib), Darzalex and Farydak, all in combination with either Revlimid (lenalidomide) or Velcade (bortezomib) plus dexamethasone in the second or third line of therapy.

Meanwhile, model costs included in the analysis were those related to drug treatment, administration, monitoring, adverse events and progression.

Regimens containing Darzalex produced the best clinical results, demonstrating the highest expected life-years, which ranged from 6.71 years to 7.38 years, as well as the highest quality-adjusted life-years among all of the triplet combinations.

The most cost-effective regimens were Darzalex plus Velcade and dexamethasone in the second line, and Farydak plus Velcade and dexamethasone in the third line. However, the researchers cautioned that the interpretation and applicability of the Farydak regimen may be challenging because of ongoing toxicity concerns.

“The analyses reported here reveal that important advances in the treatment of relapsed and/or refractory multiple myeloma have been made over the past decade, which have expanded treatment options and improved patient outcomes,” the researchers wrote. “However, only a few regimens have done so in a cost-effective manner.”

Since only two agents were found to add a significant cost-effective value to multiple myeloma regimens, the researchers highlighted the need for improved value for this patient population.

“Achieving levels of value more closely aligned with patient benefit would require substantial discounts for the remaining agents evaluated.”