title: Estimating the Costs of Therapy in Patients with Relapsed and/or Refractory Multiple Myeloma: A Model Framework.
abstract: BACKGROUND
  Multiple myeloma is a progressive cancer for which there is no cure. Despite treatment, almost all patients eventually experience periods of disease relapse and remission. With the increasing use of novel therapies, including bortezomib, lenalidomide, carfilzomib, pomalidomide, and panobinostat, benchmarks for assessing the value of these therapies in treating patients with relapsed or refractory multiple myeloma (RRMM) are needed for physicians and payers alike.
  
  
  OBJECTIVE
  To develop a model framework and to calculate an annual estimate of the total costs per patient for the treatment of patients with RRMM using 7 common treatment regimens, including bortezomib plus dexamethasone; panobinostat, bortezomib, and dexamethasone; lenalidomide plus dexamethasone; lenalidomide, bortezomib, and dexamethasone; carfilzomib; carfilzomib, lenalidomide, and dexamethasone; and pomalidomide plus dexamethasone.
  
  
  METHODS
  The expenditures for drugs and their administration, for prophylaxis and adverse event monitoring, and for the treatment of grade 3 or 4 adverse events were included in the calculations of the total pharmacy and medical costs. The drug costs were based on published pricing and labeled dosing schedules; the adverse event prophylaxis and monitoring costs were obtained from peer-reviewed publications; and the adverse event incidence rates were obtained from each regimen's prescribing information and from clinical trials. All the costs were summed over the duration of therapy for which the drugs were administered and were calculated separately for commercial and Medicare plans. The duration of therapy for each regimen was the time for which a patient had to be receiving the regimen to obtain 12 months of progression-free survival based on the duration-of-therapy to progression-free survival ratio observed from published clinical trials and/or the drug's labeling.
  
  
  RESULTS
  The pharmacy costs were highest for pomalidomide plus dexamethasone, whereas the medical costs were highest for the combination of carfilzomib, lenalidomide, and dexamethasone. The total cost associated with available treatments for RRMM was highest for regimens that included lenalidomide (approximate range, $126,000-$256,000). Only bortezomib plus dexamethasone and the combination of panobinostat, bortezomib, and dexamethasone had total costs that were lower than $125,000 per patient.
  
  
  CONCLUSIONS
  This study represents the first model developed to comprehensively estimate the costs of managing RRMM with all currently approved and guideline-recommended regimens in the United States. As such, it provides the framework and basis for further budget impact analyses and for cost-effectiveness comparisons with these regimens.
authors.affiliation: Associate Director, Health Economics and Outcomes Research, Novartis Pharmaceuticals, East Hanover, NJ.
authors.forename: Anuja
authors.initials: A
authors.lastname: Roy
authors.affiliation: Manager, Global Health Economics and Outcomes Research, Xcenda, Palm Harbor, FL.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Kish
authors.affiliation: Assistant Director, Global Health Economics and Outcomes Research, Xcenda, Palm Harbor, FL.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bloudek
authors.affiliation: Chief of the Myeloma Division, Hackensack University Medical Center, NJ.
authors.forename: David S
authors.initials: DS
authors.lastname: Siegel
authors.affiliation: Director of the Multiple Myeloma Program and Professor of Medicine, Hematology and Medical Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York.
authors.forename: Sundar
authors.initials: S
authors.lastname: Jagannath
authors.affiliation: Executive Director, US Health Economics and Outcomes Research, Novartis Pharmaceuticals, East Hanover, NJ.
authors.forename: Denise
authors.initials: D
authors.lastname: Globe
authors.affiliation: Medical Director, Novartis Pharmaceuticals, East Hanover, NJ.
authors.forename: Emil T
authors.initials: ET
authors.lastname: Kuriakose
authors.affiliation: Director, Global Health Economics and Outcomes Research, Xcenda, Palm Harbor, FL.
authors.forename: Kristen
authors.initials: K
authors.lastname: Migliaccio-Walle
keywords: costs; histone deacetylase inhibitor; immunomodulatory drug; model framework; progression-free survival; proteasome inhibitor; relapsed/refractory multiple myeloma