Cost-effectiveness of carfilzomib plus dexamethasone compared with bortezomib plus dexamethasone for patients with relapsed or refractory multiple myeloma in the United States. Issue 12 (2nd December 2017)

• Record Type: Journal Article
• Authors: Jakubowiak, Andrzej J.; Houisse, Ivan; Májer, István; Benedict, Ágnes; Campioni, Marco; Panjabi, Sumeet; Ailawadhi, Sikander
• Is Part Of: Expert review of hematology. Volume 10:Issue 12(2017)
• Page Start: 1107
• Page End: 1119
• Publication Date: 2017-12-02
• Subjects: Carfilzomib -- bortezomib -- multiple myeloma -- relapsed -- refractory -- cost effectiveness -- ENDEAVOR -- survival -- progression-free survival; Hematology -- Periodicals; 616.15005
• DOI: 10.1080/17474086.2017.1391088
• Languages: English
• ISSNs: 1747-4086

Abstract

ABSTRACT: Background : We assessed the economic value of carfilzomib 56 mg/m 2 and dexamethasone (Kd56) vs. bortezomib and dexamethasone (Vd) for relapsed/refractory multiple myeloma (R/RMM) using ENDEAVOR trial results. Methods : Cost-effectiveness of Kd56 vs. Vd was assessed using a partitioned survival model by estimating progression-free survival, overall survival, and direct costs over a lifetime horizon. Surveillance Epidemiology and End Results (SEER) survival data were extrapolated after matching registry and ENDEAVOR patients. Utilities were sourced from the literature and mapped from patient-reported quality of life in ENDEAVOR to estimate quality-adjusted life-years (QALYs) from life-years (LYs). Results : The model predicted an average gain of 1.66 LYs and 1.50 QALYs with Kd56 vs. Vd, and lifetime additional costs of $182, 699, resulting in an incremental cost-effectiveness ratio (ICER) of $121, 828/QALY gained. The ICER was $114, 793/QALY in patients with 1 prior treatment; $99, 263/QALY in those not transplanted, and <$150, 000/QALY up to an 85% discount in bortezomib price. Conclusions : Kd56 is cost-effective for patients with R/RMM at a willingness-to-pay threshold of $150, 000/QALY. Trial data in the model may limit generalizability; however, SEER registry data mitigates this challenge. Kd56 provides additional value in key subgroups, and remains cost-effective after steep comparator discounts.