Cost-effectiveness of daratumumab in combination with lenalidomide and dexamethasone for relapsed and/or refractory multiple myeloma

ABSTRACT

Objective

This study evaluates the cost-effectiveness of daratumumab (D) in combination with lenalidomide and dexamethasone (Rd) for treatment of relapsed and/or refractory multiple myeloma in patients who have received at least one prior therapy in Singapore.

Methods

A 3-state partitioned survival model was developed to evaluate the cost-effectiveness of lenalidomide and dexamethasone with or without daratumumab from a healthcare system perspective over 10 years. Clinical inputs were obtained from the POLLUX trial. Health state utilities were derived from the literature and direct medical costs obtained from public healthcare institutions. Sensitivity and scenario analyses were conducted to explore uncertainties.

Results

DRd was associated with a high base-case incremental cost-effectiveness ratio (ICER) of US$576,247 per quality-adjusted life year (QALY) gained, compared with Rd. According to one-way sensitivity analysis, ICER was most heavily influenced by time horizon, discount rate for outcomes, progression-free utility and cost of daratumumab. Regardless of the variation, DRd remained not cost-effective. Even when the cost of both daratumumab and lenalidomide dropped by 20% and 80%, the ICERs remained high at US$470,400 and US$152,860 per QALY gained.

Conclusions

At current prices, the addition of daratumumab to lenalidomide and dexamethasone does not represent cost-effective use of healthcare resources in Singapore.

KEYWORDS:

• CD38 antibody
• cost-effectiveness
• daratumumab
• partitioned survival analysis
• relapsed and/or refractory multiple myeloma

Acknowledgments

The authors would like to acknowledge Dr. Lee Cheng Phua who was formerly with Agency for Care Effectiveness for contributing to the development of the economic model, collection of data and performance of initial analyses. The authors would also like to thank Dr. Chandramouli Nagarajan from the Department of Hematology at Singapore General Hospital for his clinical inputs.

Declaration of interest

WJ Chng received honorarium from Amgen, BMS/Celgene, Abbvie, Janssen, Takeda, Novartis, and Antengene, as well as research grants from Janssen, Celgene, and ASLAN. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

XY Wong developed the economic model, collected and reviewed the data, performed the analyses, interpreted the results, drafted and revised the manuscript. WJ Chng provided clinical input, validated model assumptions and revised the manuscript. MIA Aziz contributed to the development of the economic model, review of the data, interpretation of the results and revision of the manuscript. K Ng interpreted the results and revised the manuscript. All authors read and agree for the final version of the manuscript to be published.

Supplemental Material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.