Cost-effectiveness of once weekly carfilzomib 70 mg/m2 plus dexamethasone in patients with relapsed and refractory multiple myeloma in the United States

ABSTRACT

Background

In the US, carfilzomib 70 mg⁄m² once-weekly plus dexamethasone (Kd70 QW) was recently indicated for relapsed and/or refractory multiple myeloma. In current US clinical practice, most patients treated with Kd receive carfilzomib at a previously approved dose of 27 mg/m² twice-weekly (Kd27 BIW). This analysis assessed the cost-effectiveness (CE) of Kd70 QW vs Kd27 BIW regimens which were compared in the randomized phase 3 ARROW trial.

Methods

Based on clinical outcomes (overall survival and utilities) from ARROW, a partitioned survival model was developed to estimate life years (LYs) and quality-adjusted life years (QALYs). Long-term survival was extrapolated using SEER registry data matched to ARROW patients. Costs were estimated using a US healthcare payer perspective.

Results

The analysis estimated that treatment with Kd70 QW vs Kd27 BIW resulted in an increase of 1.10 LYs, 0.91 QALYs, and additional lifetime costs of $74,858, yielding an incremental CE ratio (ratio of incremental costs to QALYs) of $82,257 per QALY gained. Results were robust to sensitivity and subgroup analyses.

Conclusions

When compared with Kd27 BIW, Kd70 QW is the optimal dose that represents a cost-effective utilization of health care budget with incremental CE ratios well below the accepted willingness-to-pay thresholds in the US.

KEYWORDS:

• Carfilzomib
• cost-effectiveness
• economic evaluation
• multiple myeloma
• progression-free Survival
• relapsed
• refractory

Acknowledgments

The authors would like to thank Jake Horgan, Niall Davison and Chrissy Almond of BresMed Health Solutions Ltd for providing writing support funded by Amgen.

Author contribution

SK provided input to model parameter choices, validated the model, revised the article critically, and approved the final version. IM built the economic model, supported drafting the manuscript and approved the final version. SP, RM, MC, and MD provided insights to the economic model, reviewed and revised the article critically, and approved the final version.

Clinical trial used for the modeling analysis

ARROW Clinical trial registration: www.clinicaltrials.gov identifier is NCT02412878 https://clinicaltrials.gov/ct2/show/NCT02412878.

Data sharing statement

Qualified researchers may request data from Amgen clinical studies. Complete details are available at the following: http://www.amgen.com/datasharing.

Declaration of interest

S.K. Kumar was supported by Amgen Celgene, Takeda, Janssen, BMS, Sanofi, KITE, Merck, Abbvie, Medimmune, Novartis, Roche-Genentech, Dr. Reddys Lab, and Ono Pharmaceuticals. I.M. Majer, Panjabi, R. Medhekar, and M. Campioni are supported by Amgen. M. Dimopoulos were supported by Abbvie, Amgen, Celgene, Janssen, and Takeda.

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

A reviewer of this manuscript discloses receiving speakers bureau from Celgene and Janssen and advisory board/consulting fees from Celgene, Janssen, Karyopharm, Antengene, Bristol Myers Squibb, Oncopeptides, Adaptive Biotechnologies and X4 Pharmaceuticals.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by Amgen (Europe) GmbH, Zug, Switzerland.