Lenalidomide for multiple myeloma: cost-effectiveness in patients with one prior therapy in England and Wales
- First Online:
- 663 Downloads
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.
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.
LEN/DEX is a cost effective oncology therapy from the perspective of the NHS for MM patients with one prior treatment.
KeywordsLenalidomide Multiple myeloma Cost effectiveness Dexamethasone Patient access scheme
- 1.Cancer Research UK: Multiple myeloma—UK incidence statistics. http://info.cancerresearchuk.org/cancerstats/types/multiplemyeloma/incidence/index.htm (2010). Accessed 19 July 2011
- 4.Drayson, M.T., Augustson, B.M., Begum, G., et al.: Survival from relapse and the influence of therapy (Abstract PO-665). Haematologica 92, 173 (2007)Google Scholar
- 10.Weber, D., Knight, R., Chen, C. et al.: Prolonged overall survival with lenalidomide plus dexamethasone compared with dexamethasone alone in patients with relapsed or refractory multiple myeloma. Blood 110, 412 (2007)Google Scholar
- 11.National Institute for Health and Clinical Excellence: Guide to the methods of technology appraisal. http://www.nice.org.uk/media/B52/A7/TAMethodsGuideUpdatedJune2008.pdf (June 2008). Accessed 19 July 2011
- 13.Ishak, K.J., Caro, J.J., Drayson, M.T., et al.: Adjusting for patient crossover in clinical trials using external data: a case study of lenalidomide for advanced multiple myeloma. Value Health 14, 672–678 (2011)Google Scholar
- 14.van Agthoven, M., Segeren, C.M., Buijt, I., et al.: A cost-utility analysis comparing intensive chemotherapy alone to intensive chemotherapy followed by myeloablative chemotherapy with autologous stem-cell rescue in newly diagnosed patients with stage II/III multiple myeloma; a prospective randomised phase III study. Eur. J. Cancer 40, 1159–1169 (2004)PubMedGoogle Scholar
- 15.Ossa, D.F., Briggs, A., McIntosh, E., Cowell, W., Littlewood, T., Sculpher, M.: Recombinant erythropoietin for chemotherapy-related anaemia: economic value and health-related quality-of-life assessment using direct utility elicitation and discrete choice experiment methods. Pharmacoeconomics 25, 223–237 (2007)PubMedCrossRefGoogle Scholar
- 20.Department of Health: The 2009 pharmaceutical price regulation scheme. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091825 (December 11, 2008). Accessed 19 July 2011
- 21.Department of Health: NHS reference costs 2008–2009. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_111591 (2010). Accessed 19 July 2011
- 23.Richards, M.: Improving access to medicines for NHS patients: a report for the Secretary of State for Health by Professor Mike Richards. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089927 (November 4, 2008). Accessed 19 July 2011
- 24.Steinbach, R.: Inequalities in the distribution of health and health care and its access, including inequalities relating to social class, gender, culture and ethnicity, and their causes. Equality, equity and policy: inequalities in the distribution of health and health care and its access. http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4c-equality-equity-policy/inequalities-distribution (2009). Accessed 19 July 2011
- 25.Department of Health: Improving outcomes: a strategy for cancer. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123394.pdf (January 2011). Accessed 29 Feb 2012