Cost per Progression Free Survival (PFS) of Daratumumab, Elotuzumab, Carfilzomib and Ixazomib Combinations with Lenalidomide/Dexamethasone (DRd, ERd, KRd, IRd) in Patients with Relapsed/Refractory Multiple Myeloma (RRMM)

OBJECTIVES: Multiple myeloma (MM) is the second most common hematological malignancy with several available therapies and an extensive pipeline. A metanalysis comparing pivotal relapsed/refractory (RRMM) studies that assessed DRd, ERd, KRd and IRd showed that DRd had the best PFS results. The goal of this analysis was to compare the cost per progression-free survival (PFS) for each of the comparators from the perspective of the Brazilian private healthcare system.

METHODS: We calculated the cost per PFS individually using the most recent available data from follow-up (FUP) studies of the therapies assessed. PFS values were based on POLLUX 3-year FUP (DRd), ENDEAVOR 4-year FUP (ERd), ASPIRE 3-year FUP (KRd) and TOURMALINE-MM1 (IRd). Only drug acquisition costs (with wastage) were considered in the analysis (according to drug label dosage) and were retrieved from the Brazilian official price list (Jul/19). Cost per PFS was calculated by dividing the total cost in the PFS period by time in PFS (in months). Cost in 18 months was assessed because it is the maximum time that carfilzomib is recommended to be used.

RESULTS: DRd showed the best PFS result compared with ERd, KRd and IRd (42.0 vs. 19.4, 26.1, 20.6, respectively). Total costs in the period of PFS for each of the comparators were BRL 2.02 million (DRd), BRL 1.29 million (ERd), BRL 1.14 million (KRd) and BRL 0.98 million (IRd). Costs per PFS- were BRL 48,060, BRL 66,343, BRL 43,822, BRL 47,760 and costs in the 18 first months were BRL 1.01 million, BRL 1,13 million, BRL 0.95 million and BRL 0.84 million for DRd, ERd, KRd and IRd, respectively.

CONCLUSIONS: DRd showed the best PFS result, however its cost per PFS is the 3^rd lowest among the comparators. As costs are directly dependent on PFS, the longer the PFS the higher are the costs. Additionally, daratumumab has continuous usage meanwhile carfilzomib has label recommended usage for just 18 cycles due to toxicity and tolerability-related events.