Daratumumab in first-line therapy is cost-effective in transplant-eligible patients with newly diagnosed myeloma
Daratumumab in first-line therapy is cost-effective in transplant-eligible patients with newly diagnosed myeloma
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DOI：
10.1182/blood.2021015220
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发表时间：
2022-08-11
期刊：
影响因子：
20.3
通讯作者：
Kanda, Yoshinobu
中科院分区：
文献类型：
--
作者：
Yamamoto, Chihiro;Minakata, Daisuke;Kanda, Yoshinobu
来那度胺、波特佐米和地塞米松(RVD)或沙利度胺、波特佐米和地塞米松(VTD)等三联方案是新诊断的多发性骨髓瘤(NDMM)移植合格患者的标准诱导疗法。在Griffin和Cassiopeia试验中，分别研究了将daratumab添加到RVD和VTD中，从而改善了微小残留病(MRD)阴性率。在这项研究中，我们进行了一项为期10年的成本-效果分析，以比较一线和二线使用daratumab治疗符合移植条件的NDMM患者。由于这些临床试验的长期随访数据尚不可用，我们开发了一个马尔可夫模型，该模型使用MRD状态来预测无进展生存率。Daratumumab用于一线联合RVD或VTD，或用于二线联合卡菲佐米加地塞米松(KD)。质量调整寿命年(QALY)和增量成本-效果比是从日本和美国支付者的角度计算的。在日本的分析中，D-RVD比RVD有更高的QALY(5.43vs5.18)和更低的成本((SIC)64479,793比(SIC)71 287569)；与VTD相比，D-VTD有更高的QALYs(5.67vs5.42)和更低的成本(SIC)43 600310比(SIC)49471,941。同样，美国的分析表明，在一线治疗方案中加入daratumumab的策略占主导地位。考虑到将daratumab用作一线方案的一部分可降低总体成本并改善结果，经济学分析表明，与将其用于二线方案相比，在一线RVD和VTD方案中添加daratumab是一种主要的策略。
Triplet regimens, such as lenalidomide, bortezomib, and dexamethasone (RVd) or thalidomide, bortezomib, and dexamethasone (VTd), are standard induction therapies for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM). The addition of daratumumab to RVd and VTd has been investigated in the GRIFFIN and CASSIOPEIA trials, respectively, resulting in improvement in the rate of minimal residual disease (MRD) negativity. In this study, we conducted a cost-effectiveness analysis with a 10-year time horizon to compare first-line and second-line use of daratumumab for transplant-eligible patients with NDMM. Because long-term follow-up data for these clinical trials are not yet available, we developed a Markov model that uses MRD status to predict progression-free survival. Daratumumab was used either in the first-line setting in combination with RVd or VTd or in the second-line setting with carfilzomib plus dexamethasone (Kd). Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were calculated from a Japanese and US payer perspective. In the Japanese analysis, D-RVd showed higher QALYs (5.43 vs 5.18) and lower costs ((sic)64479,793 vs (sic)71 287569) compared with RVd, and D-VTd showed higher QALYs (5.67 vs 5.42) and lower costs ((sic)43 600310 vs (sic)49471,941) compared with VTd. Similarly, the US analysis demonstrated dominance of a strategy incorporating daratumumab in first-line treatment regimens. Given that overall costs are reduced and outcomes are improved when daratumumab is used as part of a first-line regimen, the economic analysis indicates that addition of daratumumab to first-line RVd and VTd regimens is a dominant strategy compared with reserving its use for the second-line setting.