title: Lenalidomide for multiple myeloma: cost-effectiveness in patients with one prior therapy in England and Wales.
abstract: OBJECTIVE
  To determine the cost effectiveness of lenalidomide plus dexamethasone (LEN/DEX) versus DEX alone in managing multiple myeloma (MM) patients who have failed one prior therapy.
  
  
  METHODS
  An individual simulation model was designed to capture the costs and outcomes of LEN/DEX versus DEX therapy in relapsed refractory MM patients. MM009/010 efficacy data were adjusted for treatment cross-over and extrapolated to patient lifetime. Resource use for MM disease progression and adverse events were obtained from expert physicians and costed from the perspective of the National Health Service (England and UK) and included a patient access scheme for LEN. Utility values were obtained from published literature.
  
  
  RESULTS
  The simulation model estimated an incremental improvement in time to progression of 9.5 months, an additional 3.2 life-years, and 2.2 quality adjusted life years (QALY) for LEN/DEX compared to DEX alone. Including the costs of therapy with the patient access scheme, adverse events, and disease follow-up, the incremental cost effectiveness ratio was £30,153/QALY for LEN/DEX compared to DEX alone in MM patients who have failed one prior therapy.
  
  
  CONCLUSIONS
  LEN/DEX is a cost effective oncology therapy from the perspective of the NHS for MM patients with one prior treatment.
authors.affiliation: United BioSource Corporation, Bethesda, MD 20814, USA. ruth.brown@unitedbiosource.com
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Brown
authors.forename: Sean
authors.initials: S
authors.lastname: Stern
authors.forename: Sujith
authors.initials: S
authors.lastname: Dhanasiri
authors.forename: Steve
authors.initials: S
authors.lastname: Schey
mesh_terms: D000328:Adult; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003907:Dexamethasone / Q000191:economics* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000191:economics* / Q000627:therapeutic use; D000077269:Lenalidomide; D008297:Male; D018803:Models, Economic; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics; D016019:Survival Analysis; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006113:United Kingdom
chemical_list: D007155:Immunologic Factors; D013792:Thalidomide; D003907:Dexamethasone; D000077269:Lenalidomide