Date of Award

January 2021

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Scott F. Huntington

Abstract

COST-EFFECTIVENESS OF DARATUMUMAB IN OLDER, TRANSPLANT-INELIGIBLE PATIENTS WITH MULTIPLE MYELOMA.

Kishan K. Patel, Smith Giri, Terri Parker, Noffar Bar, Natalia Neparidze, and Scott F. Huntington. Section of Hematology/Oncology, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT.

The MAIA trial found that addition of daratumumab to lenalidomide and dexamethasone (DRd) significantly prolonged progression-free survival in transplant-ineligible patients with newly diagnosed multiple myeloma, compared to lenalidomide and dexamethasone alone (Rd). However, daratumumab is a costly treatment and is administered indefinitely until disease progression. Therefore, it is unclear whether it is cost-effective to use daratumumab in the first-line setting compared to reserving its use until later lines of therapy. In this study, we created a Markov model to compare healthcare costs and clinical outcomes of transplant-ineligible patients treated with daratumumab in the first-line setting compared to a strategy of reserving daratumumab until the second-line. We found that first-line daratumumab was associated with an incremental lifetime cost of $322,836, an incremental effectiveness of 0.52 quality-adjusted life-years (QALYs), and an incremental cost-effectiveness ratio of $618,018/QALY. The cost of daratumumab would need to be decreased by 67% for first-line daratumumab to be cost-effective at a willingness-to-pay threshold of $150,000/QALY. Based on these results, using daratumumab in the first-line setting for transplant-ineligible patients may not be cost-effective under current pricing. Delaying daratumumab until subsequent lines of therapy may be a reasonable strategy to limit healthcare costs without significantly compromising clinical outcomes. Mature overall survival data are necessary to more fully evaluate cost-effectiveness in this setting.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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