Cost Effectiveness of Transplant, Conventional Chemotherapy, and Novel Agents in Multiple Myeloma: A Systematic Review
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Treatments for multiple myeloma (MM) have been rapidly evolving. Newly developed treatment regimens are likely to be more effective but also cost more than conventional therapies.
We conducted a systematic review to compare the cost effectiveness of different classes of MM treatment.
We searched the PubMed, MEDLINE, Web of Science, and EMBASE databases for studies published during 1990–2018 comparing the cost effectiveness of transplant, chemotherapeutic and novel MM treatments. Titles and abstracts were independently reviewed for eligibility by two investigators. The quality of the included studies was evaluated using the 16-item, validated Quality of Health Economics Studies instrument.
Twenty-four publications were included in the systematic review and summarized according to treatment regimen and line. For first-line treatment, transplant was the most cost-effective option for transplant-eligible MM patients [the incremental cost-effectiveness ratio (ICER) was $4053–€45,460 per quality-adjusted life-year (QALY) gained, and $3848–$72,852 per life-year gained (LYG)], and the ICER for novel agents compared with conventional chemotherapy was $59,076 per QALY and $220,681 per LYG. For second-line treatment, in comparisons of novel agent-based regimens, ICERs were inconsistent. However, bortezomib-based regimens, lenalidomide plus dexamethasone, and pomalidomide plus dexamethasone were each cost effective compared with dexamethasone alone (ICERs showed cost saving, £30,153 per QALY gained, and €39,911 per LYG, respectively).
For transplant-eligible MM patients, transplant is a cost-effective first-line treatment. More cost-effectiveness analyses comparing novel agents in the first-line treatment regimen are warranted to determine which agent or regimen is the most cost effective. In the second-line setting, it is unclear which novel agent-based regimen is most cost effective, but bortezomib-based regimens, lenalidomide plus dexamethasone, and pomalidomide plus dexamethasone were each cost effective compared with dexamethasone alone.
The authors acknowledge the assistance with the literature search provided by Greg Pratt in the Research Medical Library, and the editorial services provided by Sarah Bronson in Scientific Publications at The University of Texas MD Anderson Cancer Center.
SF: study concept and design, data collection and interpretation, and manuscript drafting and revision. CFW: data collection and interpretation, and manuscript drafting and revision. MW: data interpretation, and manuscript drafting and revision. DRL: study concept and design, data interpretation, and manuscript drafting and revision.
Compliance with Ethical Standards
Conflict of interest
Shuangshuang Fu, Chi-Fang Wu, Michael Wang and David R. Lairson have no conflicts of interest to declare.
Sources of funding
- 1.Surveillance, epidemiology and end results program. Cancer Stat Facts: Myeloma. SEER; 2017.Google Scholar
- 2.American Society of Hematology. Myeloma; 2018. http://www.hematology.org/Patients/Cancers/Myeloma.aspx. Accessed 8 Apr 2018.
- 14.Garrison LP Jr, Wang ST, Huang H, Ba-Mancini A, Shi H, Chen K, et al. The cost-effectiveness of initial treatment of multiple myeloma in the U.S. with bortezomib plus melphalan and prednisone versus thalidomide plus melphalan and prednisone or lenalidomide plus melphalan and prednisone with continuous lenalidomide maintenance treatment. Oncologist. 2013;18(1):27–36.CrossRefGoogle Scholar
- 19.Corso A, Mangiacavalli S, Cocito F, Pascutto C, Ferretti VV, Pompa A, et al. Long term evaluation of the impact of autologous peripheral blood stem cell transplantation in multiple myeloma: a cost-effectiveness analysis [published erratum appears in PLoS One. 2014;9(1). doi:10.1371/annotation/949c27ad-65b0-4926-8c7b-5a45d67b1be9]. PLoS One. 2013;8(9):e75047.CrossRefGoogle Scholar
- 20.Shah GL, Winn AN, Lin PJ, Klein A, Sprague KA, Smith HP, et al. Cost-effectiveness of autologous hematopoietic stem cell transplantation for elderly patients with multiple myeloma using the surveillance, epidemiology, and end results-medicare database. Biol Blood Marrow Transplant. 2015;21(10):1823–9.CrossRefGoogle Scholar
- 29.Pelligra CG, Parikh K, Guo S, Chandler C, Mouro J, Abouzaid S, et al. Cost-effectiveness of pomalidomide, carfilzomib, and daratumumab for the treatment of patients with heavily pretreated relapsed-refractory multiple myeloma in the United States. Clin Ther. 2017;39(10):1986–2005.e5.CrossRefGoogle Scholar
- 32.Jakubowiak AJ, Houisse I, Majer I, Benedict A, Campioni M, Panjabi S, et al. Cost-effectiveness of carfilzomib plus dexamethasone compared with bortezomib plus dexamethasone for patients with relapsed or refractory multiple myeloma in the United States. Expert Rev Hematol. 2017;10(12):1107–19.CrossRefGoogle Scholar
- 35.Neumann PJ, Ganiats TG, Russell LB, Sanders GD, Siegel JE, Oxford University Press. Cost-effectiveness in health and medicine. New York: Oxford University Press; 2017.Google Scholar