Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden.
BACKGROUND
Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden.


METHODS
We developed a health-economic discrete event simulation model of a patient's course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature.


RESULTS
The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (€19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (€81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (€62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental cost-effectiveness ratio is SEK 798 613 (€84 900) per QALY gained.


CONCLUSIONS
In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.
a Health Economics Unit, Department of Clinical Sciences in Malmö , Lund University , Medicon Village , Lund , Sweden .|b The Swedish Institute for Health Economics (IHE) , Lund , Sweden .
Sixten
S
Borg
c Department of Medicine , MedH H7, Karolinska Institute , Stockholm , Sweden .
Hareth
H
Nahi
d Department of Hematology and Transfusion Medicine , Lund University, B13, BMC , Lund , Sweden , and.
Markus
M
Hansson
e BresMed , Sheffield , UK.
Dawn
D
Lee
e BresMed , Sheffield , UK.
Jamie
J
Elvidge
b The Swedish Institute for Health Economics (IHE) , Lund , Sweden .
Ulf
U
Persson
D020533:Angiogenesis Inhibitors / Q000191:economics* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D000069286:Bortezomib / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003907:Dexamethasone / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D000077269:Lenalidomide; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000191:economics; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D013548:Sweden; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; C467566:pomalidomide; D000077269:Lenalidomide