Abstract
Purpose
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.
Materials and 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.
Conclusion
LEN/DEX is a cost effective oncology therapy from the perspective of the NHS for MM patients with one prior treatment.
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Acknowledgements
The authors wish to acknowledge statistical support from Jack Ishak, PhD, and production support from Fritz Hamme, BA, both of UBC. This work was supported by a grant from Celgene UK & Ireland. R.B. conducted the research and contributed to the manuscript. S. Stern constructed the economic model and contributed to the manuscript. S.D. advised on sensitivity analyses and the patient access plan, and contributed to the manuscript. S. Schey provided a clinical level review of research and the manuscript, and contributed to the manuscript’s discussion.
Conflict of interest
Ruth Brown and Sean Stern have received research funding from Celgene. Steve Schey has been compensated for his consultant role with Celgene. Sujith Dhanasiri works for Celgene and is compensated.
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Brown, R.E., Stern, S., Dhanasiri, S. et al. Lenalidomide for multiple myeloma: cost-effectiveness in patients with one prior therapy in England and Wales. Eur J Health Econ 14, 507–514 (2013). https://doi.org/10.1007/s10198-012-0395-6
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DOI: https://doi.org/10.1007/s10198-012-0395-6