title: The cost-effectiveness of initial treatment of multiple myeloma in the U.S. with bortezomib plus melphalan and prednisone versus thalidomide plus melphalan and prednisone or lenalidomide plus melphalan and prednisone with continuous lenalidomide maintenance treatment.
abstract: The outlook for transplant-ineligible multiple myeloma patients has improved enormously over recent years with the incorporation of new agents into standard regimens. Novel regimens combine melphalan and prednisone (MP) with bortezomib (VMP), with thalidomide (MPT), and with lenalidomide with (MPR-R) and without (MPR) lenalidomide maintenance. The efficacy, safety, and cost-effectiveness of these regimens have not yet been compared; therefore, we conducted a pharmacoeconomic analysis using data from randomized controlled trials versus MP. Using a Markov model developed from a U.S. payer's perspective, we compared VMP with MPT and MPR-R over a lifetime horizon. MPT and MPR-R were chosen because, like VMP, they are superior to MP in response and outcomes. Data from the Velcade as Initial Standard Therapy in Multiple Myeloma (VISTA; VMP), Intergroupe Francophone du Myelome (IFM) 99-06 (MPT), and MM-015 (MPR-R) trials were used. The IFM 99-06 study was selected because of the superior activity in this study compared with other MPT studies. Using patient-level (VMP) and published (MPT, MPR-R) data, we estimated the health-state transition and adverse event probabilities for each regimen, related costs, and state-specific utility estimates. Costs (in 2010 U.S. dollars) and health outcomes were discounted at 3%. Discounted lifetime direct medical costs were lowest with VMP at $119,102. MPT cost $142,452 whereas MPR-R cost $248,358. Incremental cost-effectiveness ratio calculations projected that VMP would confer cost savings and better health outcomes relative to MPT and MPR-R. We conclude that VMP is highly likely to be cost-effective compared with MP, MPT, and MPR-R.
authors.affiliation: University of Washington School of Pharmacy, Box 357630, Seattle, Washington 98195, USA. lgarrisn@u.washington.edu
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
authors.forename: Si-Tien
authors.initials: ST
authors.lastname: Wang
authors.forename: Hui
authors.initials: H
authors.lastname: Huang
authors.forename: Abbie
authors.initials: A
authors.lastname: Ba-Mancini
authors.forename: Hongliang
authors.initials: H
authors.lastname: Shi
authors.forename: Kristina
authors.initials: K
authors.lastname: Chen
authors.forename: Caroline
authors.initials: C
authors.lastname: Korves
authors.forename: Ravinder
authors.initials: R
authors.lastname: Dhawan
authors.forename: Andrew
authors.initials: A
authors.lastname: Cakana
authors.forename: Helgi
authors.initials: H
authors.lastname: van de Velde
authors.forename: Deyanira
authors.initials: D
authors.lastname: Corzo
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D018849:Controlled Clinical Trials as Topic; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008390:Markov Chains; D008558:Melphalan / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D011719:Pyrazines / Q000008:administration & dosage; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives; D014481:United States
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide; D008558:Melphalan; D011241:Prednisone