First-line autologous stem cell transplant (ASCT) is cost-effective in patients with newly diagnosed multiple myeloma (MM) but more research is needed to assess cost-effectiveness of other, newer antimyeloma regimens in different treatment-line settings, according to a systematic review of studies from 11 countries published over the past quarter of a century. The analysis was published in the journal PharmacoEconomics.
For transplant-eligible MM patients, transplant isa cost-effective first-line treatment, reported senior study author ProfessorDavid R. Lairson, PhD, co-director of the Center for Health Services Researchat the University of Texas MD Anderson Cancer Center in Houston, and coauthors.
However, the evidence for the relative costeffectiveness of other treatment regimens remains unclear and more research isneeded, the researchers noted. Second-line bortezomib-based regimens,lenalidomide plus dexamethasone, and pomalidomide plus dexamethasone were each cost-effectivecompared with dexamethasone alone but which of these combinatorial regimens isthe most cost-effective remains unclear.
MM incidence rates have climbed in recent years, asbaby boomers aged into late adulthood. MM treatment strategies have beenchanging rapidly over recent years, as well, thanks to newly approved agentsand treatment regimens. Newer regimens are promising and benefit some patients;however, none are considered curative.
Previous systematic reviews have compared specifictherapies. However, few comprehensive cost-effectiveness analyses have beenundertaken that compare available therapies across treatment lines.
To compare the cost effectiveness of treatmentregimes, the authors searched research literature databases and identified 24such assessments, published between 1990 and 2018, summarizing incrementalcost-effectiveness ratio (ICER), quality-adjusted life-year (QALY), andlife-year gained (LYG) for different treatment regimens and treatment lines(first-line, second-line, and multiple-line treatments).
Unpublished literature, including someindustry-sponsored studies and reports, or non-English reports, were notincluded, cautioned the researchers. In addition, 2 studies were not availablein the databases searched and their exclusion from the analysis might havebiased their results, the team acknowledged.
Four studies included in the review had comparedtransplant and no-transplant treatments cost-effectiveness. Amongtransplant-eligible patients, first-line transplant was the mostcost-effective option, with an ICER of at least $4053 per QALY gained andbetween $3848 and $72,852 per LYG. Compared with conventional chemotherapy,first-line novel agents (bortezomib, thalidomide, and lenalidomide) had an ICERof $59,076 per QALY gained and $220,681 per LYG. ASCT in patients with new diagnoseswas cost effective compared with melphalan, the researchers reported (ICER of $25,710per LYG).
Second-line novel agent regimens had inconsistentICERs, the researchers reported.
More cost-effectiveness analyses comparing novelagents in the first-line treatment regimen are warranted to determine whichagent or regimen is the most cost-effective, the researchers concluded.
[T]he papers included in this review were conductedfrom different perspectives, countries, and years, and using differentcost-effectiveness criteria, the researchers noted. [R]eaders need to usecaution when interpreting the conclusions in the context of their localjurisdiction and cost-effectiveness criteria.
Multiple myeloma caused 12,590 deaths in 2017,representing 2% of all US cancer deaths.
This article originally appeared on Oncology Nurse Advisor
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