According to the results of a study published in ClinicoEconomics and Outcomes Research, the introduction of selinexor, bortezomib, and dexamethasone (XVd) for the treatment of patients with previously treated multiple myeloma (MM) presents a manageable budget impact for a private third-party payer and Medicare in the US.
The study authors built upon a previous budget impact model to compare two scenarios for previously treated MM patients, one without the introduction of XVd vs one with the introduction of XVd from the perspective of a private third-party US payer (with 1,000,000 members) and Medicare (with 59,499,015 members) in 1-year increments for 3 years.
The total annual treatment costs were calculated as the sum of XVd costs, costs of treating serious treatment emergent adverse events (TEAEs; defined as grade ≥3), ongoing best supportive care costs, and mortality costs. The model included XVd therapy and efficacy and safety outcomes based upon those in the BOSTON (bortezomib, selinexor, and low dose dexamethasone treatment in patients with MM) phase 3 trial (ClinicalTrials.gov Identifier: NCT03110562), which demonstrated that once-weekly triplet XVd was superior in most efficacy endpoints and resulted in fewer clinic visits associated with AEs relative to standard twice-weekly Vd.
From the private third-party payer plan population, 47 to 49 patients each year would be considered eligible for XVd, of which 3 to 4 were projected to be treated with XVd. From the Medicare population, 22,892 to 23,425 patients each year would be considered eligible for XVd, of whom 1361 to 1808 were projected to be treated with XVd. The monthly total drug cost and estimated severe TEAE cost of XVd treatment was $29,813 and $166, respectively, per patient treated with the regimen.
From a private third-party payer plan perspective, the absolute budget impact of the introduction of XVd was $0.06, $0.07, $0.08, and $0.22 (millions, USD) for years 1, 2, 3, and overall, respectively. The relative budget impact of XVd was 0.33%, 0.40%, 0.43%, and 0.38% for years 1, 2, 3, and overall, respectively. The per member per month (PMPM) budget impact was $0.005, $0.006, $0.007, and $0.006 (USD), for years 1, 2, 3, and overall, respectively.
From the Medicare perspective, the absolute budget impact of the introduction of XVd was $29.68, $36.62, $39.42, and $105.72 (millions, USD) for years 1, 2, 3, and overall, respectively. The relative budget impact of XVd was 0.33%, 0.40%, 0.43%, and 0.38% for years 1, 2, 3, and overall, respectively. The PMPM budget impact of $0.041, $0.051, $0.054, and $0.049 (USD), for years 1, 2, 3, and overall, respectively.
Limitations of the study included potential misalignment between the medical resource utilization data and the BOSTON trial population data, which were obtained from externally published literature, and partial over/underestimation of some costs due to model assumptions and incidence structure.
“Total medical costs, adverse event costs, and mortality costs were not notably different in either scenario, but secondary therapy costs were lower in the XVd scenario,” the authors wrote in their report. “This study determined that XVd has a relatively small and manageable budget impact for a private third-party US payer and Medicare.”
Disclosure: This research was supported by Karyopharm Therapeutics. Please see the original reference for a full list of disclosures.
Dolph M, Tremblay G, Leong H. US budget impact model for selinexor, bortezomib, and dexamethasone for the treatment of previously treated multiple myeloma. Clinicoecon Outcomes Res. 2021;13:493-502. doi:10.2147/CEOR.S305830