Cost a Barrier to Daratumumab-Containing Regimens in First-Line Treatment of Multiple Myeloma

A cost analysis that compared daratumumab in the first-line treatment of newly diagnosed multiple myeloma in transplant-ineligible patients with its use in second-line treatment suggests the latter is the more cost-effective strategy. These results were published in the Journal of Clinical Oncology.

Progression-free survival (PFS) was significantly prolonged when daratumumab, a novel CD38-targeted monoclonal antibody, was added to standard-of-care regimens for relapsed or refractory (R/R) multiple myeloma. In the phase 3 MAIA trial, transplant-ineligible patients with newly diagnosed multiple myeloma were randomly assigned to receive daratumumab, lenalidomide, and dexamethasone (DRd) or lenalidomide and dexamethasone (Rd) alone in the first-line setting.

Estimated 30-month PFS rates were 70.6% for DRd and 55.6% for Rd, supporting the use of daratumumab-containing triplet regimens for the treatment of newly diagnosed as well as R/R multiple myeloma in patients who are ineligible for autologous stem cell transplantation.

However, this treatment comes at a significant cost that is further exacerbated by the potential for prolonged treatment duration. Therefore, a team of investigators at Yale University School of Medicine in New Haven, Connecticut, sought to determine the cost-effectiveness of daratumumab in the first-line setting compared with its use as a second-line treatment for transplant-ineligible patients with multiple myeloma.

Patients in this trial were comparable to the study cohort in the MAIA trial: median age was 73 years, 14.3% had a high-risk cytogenetic profile, and all patients were ineligible for stem cell transplantation due to age (older than 65) or comorbidities.

Using a 1-month Markov cycle and estimates of costs and utility associated with the 2 treatment strategies, they constructed a cost-effectiveness model to calculate the incremental cost-effectiveness ratio (ICER), which represented the cost in 2020 US dollars for each additional quality-adjusted life-year (QALY) gained from treatment.

“Our model suggests that use of daratumumab in the first-line setting is unlikely to be cost-effective compared with reserving its use until the second-line, with an ICER of $618,018 per QALY,” the authors reported. However, in this base-case model, use of daratumumab in the second-line setting would still incur an average direct healthcare cost of more than $1.1 million per patient.

Based on their results, the study authors suggest reserving daratumumab for second-line treatment as the more cost-effective strategy. “Significant price reductions or establishing the efficacy of a fixed duration of therapy would likely be necessary to make daratumumab cost-effective as a first-line therapy,” they concluded.

Disclosures: Multiple authors declared affiliation with or received funding from the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Patel KK, Giri S, Parker TL, Bar N, Neparidze N, Huntington SF. Cost-effectiveness of first-line versus second-line use of daratumumab in older, transplant-ineligible patients with multiple myeloma. J Clin Oncol. Published online January 7, 2021. doi:10.1200/jco.20.01849