A recent cost-effectiveness analysis compared novel agents and chemotherapy for older Medicare patients with multiple myeloma, published in the Journal of Managed Care & Specialty Pharmacy (August 2017;23:831-843).
Multiple myeloma treatments are often costly and produce a substantial economic burden in care management. Recent discussions have focused on the costs of novel anti-myeloma drugs and their associated value. Assessments that quantify value of multiple myeloma care over the long-term are essential, due to these high costs.
Researchers from the University of Texas led by Ying Chen, MS, department of epidemiology, conducted a cost-effectiveness analysis of front-line novel agent therapy use among older Medicare patients with multiple myeloma in a real-world setting. A total of 2551 patient were identified from 2000 to 2009 who initiated novel agent therapy (bortezomib, lenalidomide, or thalidomide) or chemotherapy from the Surveillance, Epidemiology, and End Results-Medicare linked data. Twenty-month cost of care and overall survival (0S) related to multiple myeloma were compared between patients in either treatment cohort. A net monetary benefit approach and cost-effectiveness acceptability curves were utilized to determine the cost-effectiveness of novel agent therapy.
Researchers found that the average 12-month costs were 2.03-fold higher for novel agent therapy ($144,665) compared with chemotherapy ($47,750). Anti-myeloma pharmacy costs comprised 31% ($45,095) of total care costs for patients in the novel agent cohort, but only comprised 19% ($8921) of total care costs for patients in the chemotherapy cohort.
Twelve-month OS rates increased significantly for patients in the novel agent cohort. However, the incremental net monetary benefit analysis—once adjusted for variable such as sex, race, and socioeconomic status, among others—showed that novel agents were only cost-effective compared with chemotherapy when the willingness-to-pay thresholds were high (approximately $230,000).
Authors of the study concluded that use of novel agent therapy is not cost-effective at its current level of cost and effectiveness in older Medicare patients with multiple myeloma. “Future studies should evaluate the generalizability of these results by evaluating cost-effectiveness of novel [agent] therapy use in different patient populations,” they wrote.—Zachary Bessette