The European Journal of Health Economics

, Volume 14, Issue 3, pp 507–514

Lenalidomide for multiple myeloma: cost-effectiveness in patients with one prior therapy in England and Wales

  • Ruth E. Brown
  • Sean Stern
  • Sujith Dhanasiri
  • Steve Schey
Original Paper

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.

Keywords

Lenalidomide Multiple myeloma Cost effectiveness Dexamethasone Patient access scheme 

JEL Classification

I13 

References

  1. 1.
    Cancer Research UK: Multiple myeloma—UK incidence statistics. http://info.cancerresearchuk.org/cancerstats/types/multiplemyeloma/incidence/index.htm (2010). Accessed 19 July 2011
  2. 2.
    Scott, L.J., Lyseng-Williamson, K.A.: Lenalidomide: a review of its use in the treatment of relapsed or refractory multiple myeloma. Drugs 71, 625–649 (2011)PubMedCrossRefGoogle Scholar
  3. 3.
    Schey, S., Higginson, I.: Cost-effectiveness of lenalidomide in multiple myeloma. Expert Rev. Pharmacoecon. Outcomes Res. 10, 229–238 (2010)PubMedCrossRefGoogle Scholar
  4. 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
  5. 5.
    Kumar, S.K., Rajkumar, S.V., Dispenzieri, A., et al.: Improved survival in multiple myeloma and the impact of novel therapies. Blood 111, 2516–2520 (2008)PubMedCrossRefGoogle Scholar
  6. 6.
    Stadtmauer, E.A., Weber, D.M., Niesvizky, R., et al.: Lenalidomide in combination with dexamethasone at first relapse in comparison with its use as later salvage therapy in relapsed or refractory multiple myeloma. Eur. J. Haematol. 82, 426–432 (2009)PubMedCrossRefGoogle Scholar
  7. 7.
    Dimopoulos, M.A., Palumbo, A., Attal, M., et al.: Optimizing the use of lenalidomide in relapsed or refractory multiple myeloma: consensus statement. Leukemia 25, 749–760 (2011)PubMedCrossRefGoogle Scholar
  8. 8.
    Caro, J.J.: Pharmacoeconomic analyses using discrete event simulation. Pharmacoeconomics 23, 323–332 (2005)PubMedCrossRefGoogle Scholar
  9. 9.
    Dimopoulos, M., Spencer, A., Attal, M., et al.: Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N. Engl. J. Med. 357, 2123–2132 (2007)PubMedCrossRefGoogle Scholar
  10. 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. 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
  12. 12.
    Durie, B.G., Harousseau, J.L., Miguel, J.S., et al.: International uniform response criteria for multiple myeloma. Leukemia 20, 1467–1473 (2006)PubMedCrossRefGoogle Scholar
  13. 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. 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. 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
  16. 16.
    Lloyd, A., Nafees, B., Narewska, J., Dewilde, S., Watkins, J.: Health state utilities for metastatic breast cancer. Br. J. Cancer 95, 683–690 (2006)PubMedCrossRefGoogle Scholar
  17. 17.
    Cykert, S., Joines, J.D., Kissling, G., Hansen, C.J.: Racial differences in patients’ perceptions of debilitated health states. J. Gen. Intern. Med. 14, 217–222 (1999)PubMedCrossRefGoogle Scholar
  18. 18.
    Coffey, J.T., Brandle, M., Zhou, H., et al.: Valuing health-related quality of life in diabetes. Diabetes Care 25, 2238–2243 (2002)PubMedCrossRefGoogle Scholar
  19. 19.
    Mathias, S.D., Putterman, C.G., Prebil, L.A., et al.: A health-related quality of life measure in patients with deep vein thrombosis: a validation study. Drug Inf. J. 33, 1173–1187 (1999)CrossRefGoogle Scholar
  20. 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. 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
  22. 22.
    Richardson, P.G., Weller, E., Lonial, S., et al.: Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myeloma. Blood 116, 679–686 (2010)PubMedCrossRefGoogle Scholar
  23. 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. 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. 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

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Ruth E. Brown
    • 1
  • Sean Stern
    • 1
  • Sujith Dhanasiri
    • 2
  • Steve Schey
    • 3
  1. 1.United BioSource CorporationBethesdaUSA
  2. 2.Celgene Ltd. (UK and Ireland)Stockley ParkUK
  3. 3.King’s College HospitalLondonUK

Personalised recommendations