A cost-utility analysis comparing intensive chemotherapy alone to intensive chemotherapy followed by myeloablative chemotherapy with autologous stem-cell rescue in newly diagnosed patients with stage II/III multiple myeloma; a prospective randomised phase III study.
A prospective randomised phase III study in patients < or =65 years old with previously untreated multiple myeloma (MM), intensive chemotherapy followed by myeloablative chemotherapy and autologous stem-cell rescue was compared with intensive chemotherapy alone. This economic evaluation was based on detailed data from patient charts and hospital information systems. In the intention-to-treat analysis, mean total treatment and follow-up costs of the myeloablative treatment arm were 81,643 euros compared to 68,802 euros for the chemotherapy arm (P=0.09). Costs per quality-adjusted life year were 51,357 euros versus 37,328 euros. In the clinical study, no significant differences were found in overall survival after a median follow-up of 33 months from randomisation. Intensive chemotherapy is regarded as standard therapy for younger patients with previously untreated MM. Cost-effectiveness of myeloma therapy after 3 years of follow up seems not to be favoured by myeloablative treatment with autologous stem-cell rescue.
van Agthoven
M
M
Institute for Medical Technology Assessment, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands. vanagthoven@bmg.eur.nl
Segeren
C M
CM
Buijt
I
I
Uyl-de Groot
C A
CA
van der Holt
B
B
Lokhorst
H M
HM
Sonneveld
P
P
D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003520:Cyclophosphamide / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D008558:Melphalan / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000191:economics* / Q000628:therapy; D011446:Prospective Studies; D014182:Transplantation, Autologous
D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide; D008558:Melphalan