Date of Award
Medical Doctor (MD)
Scott F. Huntington
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.
Patel, Kishan, "Cost-Effectiveness Of Daratumumab In Older, Transplant-Ineligible Patients With Multiple Myeloma" (2021). Yale Medicine Thesis Digital Library. 4025.