Adding daratumumab to standard care may improve outcomes, but it is not cost-effective for patients with untreated multiple myeloma (MM), according to research published in Frontiers in Pharmacology.
MM is the second most common hematologic malignancy in the world, and despite treatment advances, it remains incurable. Combination therapy with bortezomib, melphalan, and prednisone (VMP) is a standard treatment for patients with newly diagnosed, transplant-ineligible MM. The addition of daratumumab to standard treatment has reduced the risk of disease progression or death; however, it costs significantly more than VMP.
The study authors evaluated the cost-effectiveness of daratumumab plus VMP (D-VMP) versus VMP for this patient population. They developed a decision-analytic Markov model to simulate patients from the progression-free survival (PFS) state. Their model included 350 patients in the D-VMP group and 356 in the VMP group.
The threshold of willingness to pay per quality-adjusted life-years (QALYs) was set at $150,000. Their analysis considered only direct medical care costs and was conducted from the perspective of U.S. payers.
They used data from the ALCYONE trial to simulate PFS and overall survival outcomes for each treatment regimen.
Patients receiving D-VMP gained 6.40 QALYs, which is 2.03 QALYs more than patients receiving VMP, but at an incremental cost of $388,364 per QALY. The mean incremental costs of D-VMP were $788,541.
This was the first cost-effectiveness analysis of daratumumab for patients with newly diagnosed, transplant-ineligible MM. However, other studies of patients with relapsed or refractory MM often found that the high cost of daratumumab was not cost-effective when compared to clinical benefit.
In this study, a sensitivity analysis found that, even when adjusting for multiple parameters, the incremental cost-effectiveness ratio remained more than $150,000. With that threshold, adding daratumumab to VMP is not cost-effective.
Cao Y, Zhao L, Zhang T, Cao W. Cost-effectiveness analysis of adding daratumumab to bortezomib, melphalan, and prednisone for untreated multiple myeloma. Front Pharmacol. Published online March 1, 2021. doi:10.3389/fphar.2021.608685