The use of daratumumab as a second-line treatment may be more cost effective compared with use as a first-line for patients with multiple myeloma who are transplant ineligible, according to study results reported in the Journal of Clinical Oncology.

“To our knowledge, this is the first cost-effectiveness analysis of daratumumab in the first-line setting,” explained the investigators in their report.

Using Markov modeling, the researchers analyzed lifetime direct healthcare costs, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) for a comparison of first-line vs second-line use of daratumumab for transplant-ineligible patients with multiple myeloma. Costs were considered using a US-based payer perspective.


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The researchers’ model showed that first-line treatment with daratumumab was linked to an improvement of 0.52 QALYs and 0.66 discounted life-years, in comparison with second-line use. In the study’s base-case analysis, however, lifetime individual healthcare costs of use of daratumumab were much higher in the first-line setting, with a cost of $1,434,937 for first-line use and $1,112,101 for second-line use. First-line use of daratumumab was associated with an ICER of $618,018 per QALY.

According to the researchers, multiple scenarios placed the cost of first-line daratumumab use above a willingness-to-pay cap of $150,000 per QALY. To be cost effective at this threshold, the cost of first-line daratumumab would have to be reduced by approximately 67%.

Estimated long-term clinical outcomes were also modeled. In this analysis, first-line daratumumab was associated with a median nonfuture-discounted overall survival time of 7.50 years, compared with 6.75 years when daratumumab was delayed. Median duration of exposure was longer in this analysis for first-line use (53 months) in comparison with second-line use (17 months).

The researchers noted that while this study may suggest a greater value with second-line use of daratumumab, certain patient populations may achieve greater value with earlier use. High-risk cytogenetics may make a patient more vulnerable to earlier disease progression, which could favor the use of first-line daratumumab.

“In conclusion, for older adults with multiple myeloma who are ineligible for transplant, our study suggests that the more cost-effective strategy is reserving daratumumab for second-line use,” the researchers stated in their report. They also noted that survival data with first-line daratumumab use need to mature in order to better characterize the cost-effectiveness of this treatment approach.

Disclosure: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

Reference

Patel KK, Giri S, Parker TL, Bar N, Naparidze N, Huntington SF. Cost-effectiveness of first-line versus second-line use of daratumumab in older, transplant-ineligible patients with multiple myeloma. J Clin Oncol. Published January 7, 2021. doi:10.1200/JCO.20.01849