Cost-effectiveness of idecabtagene vicleucel compared with conventional care in triple-class exposed relapsed/refractory multiple myeloma patients in Canada and France. (31st December 2023)

• Record Type: Journal Article
• Authors: Karampampa, Korinna; Zhang, Wenjie; Venkatachalam, Meena; Cotte, Francois-Emery; Dhanda, Devender
• Is Part Of: Journal of medical economics. Volume 26:Number 1(2023)
• Page Start: 243
• Page End: 253
• Publication Date: 2023-12-31
• Subjects: RRMM -- CAR T therapy -- partitional survival model -- individual patient level analysis; D40 -- D4 -- D -- O52 -- O5 -- O -- O51; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2023.2173466
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Background: The chimeric antigen receptor (CAR) T-cell therapy idecabtagene vicleucel (ide-cel) is approved for the treatment of adult patients with relapsed/refractory multiple myeloma (RRMM) who have already received an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 antibody and have progressed on their last therapy. The objective of this study was to assess the cost-effectiveness of ide-cel versus conventional care in Canada and France. Methods: A partitioned survival model was used to estimate the cost-effectiveness of ide-cel (target dose 450 × 10 6 CAR T cells) in its approved indication in terms of life-years (LYs), quality-adjusted LYs (QALYs), and costs. Patient-level data from the KarMMa Phase II clinical trial (clinicaltrials.gov NCT03361748) and KarMMa-RW study were used to inform the model; overall and progression-free survival were extrapolated using standard parametric functions after the observed periods. The model adopted Canadian and French societal perspectives over a lifetime horizon. Costs, utilities, discounting (Canada: 1.5%, France: 2.5%), and general population mortality were country-specific. Results: The base case demonstrated that ide-cel was associated with more additional LYs (+2.64 and +2.51) and QALYs (+2.31 and +2.54) than conventional care at incremental costs of CAN$588, 490 and €392, 251 in Canada and France, respectively. The resulting incremental cost-effectiveness ratio (ICER) for ide-cel was $255, 245 per QALY in Canada, and €154, 593 per QALY in France. Conclusion: Ide-cel was associated with significant survival improvements in terms of both LYs and QALYs in patients with progressive triple-class-exposed RRMM. The ICER for ide-cel was similar to that of other approved and reimbursed RRMM therapies.