Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden
(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.
(Less)
- author
- Borg, Sixten LU ; Nahi, Hareth ; Hansson, Markus LU ; Lee, Dawn ; Elvidge, Jamie and Persson, Ulf
- organization
- publishing date
- 2016
- 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
- 2024-07-12 05:21:55
@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}}, }