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Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden

Borg, Sixten LU ; Nahi, Hareth ; Hansson, Markus LU orcid ; Lee, Dawn ; Elvidge, Jamie and Persson, Ulf (2016) In Acta Oncologica 55(5). p.554-560
Abstract

Background: Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. Material and methods: We developed a health-economic discrete event simulation model of a patient’s course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years... (More)

Background: Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. Material and methods: We developed a health-economic discrete event simulation model of a patient’s course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature. Results: The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (€19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (€81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (€62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental cost-effectiveness ratio is SEK 798 613 (€84 900) per QALY gained. Conclusion: In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Oncologica
volume
55
issue
5
pages
554 - 560
publisher
Taylor & Francis
external identifiers
  • pmid:27123742
  • wos:000375566700004
  • scopus:84947227326
ISSN
0284-186X
DOI
10.3109/0284186X.2015.1096021
language
English
LU publication?
yes
id
6a1cbb3e-67a9-4920-bf1e-37b1e1eab55c
date added to LUP
2016-04-12 12:41:32
date last changed
2024-01-18 22:10:38
@article{6a1cbb3e-67a9-4920-bf1e-37b1e1eab55c,
  abstract     = {{<p>Background: Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. Material and methods: We developed a health-economic discrete event simulation model of a patient’s course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature. Results: The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (€19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (€81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (€62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental cost-effectiveness ratio is SEK 798 613 (€84 900) per QALY gained. Conclusion: In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.</p>}},
  author       = {{Borg, Sixten and Nahi, Hareth and Hansson, Markus and Lee, Dawn and Elvidge, Jamie and Persson, Ulf}},
  issn         = {{0284-186X}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{554--560}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Oncologica}},
  title        = {{Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden}},
  url          = {{http://dx.doi.org/10.3109/0284186X.2015.1096021}},
  doi          = {{10.3109/0284186X.2015.1096021}},
  volume       = {{55}},
  year         = {{2016}},
}