The cost-effectiveness of bortezomib in relapsed/refractory multiple myeloma: Swedish perspective.
OBJECTIVE
To estimate the cost-effectiveness of bortezomib (BTZ) compared with dexamethasone (DEX) and lenalidomide plus dexamethasone (LEN/DEX) for the treatment of relapsed/refractory multiple myeloma in Sweden.


METHODS
We used partitioned survival analysis to assess survival data decomposed into three states: (i) alive before disease progression; (ii) alive after progression; and (iii) dead. The effects of treatment on time to progression and overall survival (OS) were obtained from published reports of the APEX, MM-009, and MM-010 randomized clinical trials. Costs included drug and administration costs, adverse events, treatment of relapses, and end-of-life costs. Utility estimates were derived from the literature.


RESULTS
BTZ mean OS was 57.4 months compared with 44.6 and 54.1 months for DEX and LEN/DEX, respectively. Mean lifetime direct medical costs per patient were approximately 2010 SEK 1,904,462, 1,278,854, and 2,450,588 for BTZ, DEX, and LEN/DEX, respectively. Mean incremental cost per quality-adjusted life-year of BTZ compared to DEX was 2010 SEK 902,874 (€95,073) (95% CI: 514,791, 962,416) and was dominant with respect to LEN/DEX.


CONCLUSIONS
BTZ and LEN/DEX are projected to prolong survival relative to DEX. From a Swedish perspective, BTZ is cost-effective compared to DEX and LEN/DEX.
Hornberger
John
J
Cedar Associates LLC, Menlo Park, CA, USA. ujch@stanford.edu
Rickert
Joseph
J
Dhawan
Ravinder
R
Liwing
Johan
J
Aschan
Johan
J
Löthgren
Mikael
M
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics*; D001897:Boronic Acids / Q000008:administration & dosage / Q000191:economics*; D000069286:Bortezomib; D017326:Clinical Trials, Phase III as Topic; D003365:Costs and Cost Analysis; D003907:Dexamethasone / Q000008:administration & dosage / Q000191:economics; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009101:Multiple Myeloma / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D011719:Pyrazines / Q000008:administration & dosage / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015996:Survival Rate; D013548:Sweden; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics
D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D000077269:Lenalidomide