Cost-Effectiveness of Novel Agent Regimens for Transplant-Eligible Newly Diagnosed Multiple Myeloma Patients in India

Jyoti Dixit, Pankaj Malhotra (), Nikita Mehra, Anisha Mathew, Lalit Kumar, Ashish Singh, Nidhi Gupta, Manjunath Nookala Krishnamurthy, Partha Sarathi Roy, Amal Chandra Kataki, Sudeep Gupta and Shankar Prinja ()
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Jyoti Dixit: Post Graduate Institute of Medical Education and Research (PGIMER)
Pankaj Malhotra: Post Graduate Institute of Medical Education and Research (PGIMER)
Nikita Mehra: Adyar Cancer Institute
Anisha Mathew: All India Institute of Medical Sciences (AIIMS)
Lalit Kumar: All India Institute of Medical Sciences (AIIMS)
Ashish Singh: Christian Medical College
Nidhi Gupta: Government Medical College and Hospital
Manjunath Nookala Krishnamurthy: Tata Memorial Centre
Partha Sarathi Roy: Dr. B. Booroah Cancer Institute
Amal Chandra Kataki: Dr. B. Booroah Cancer Institute
Sudeep Gupta: Tata Memorial Centre
Shankar Prinja: Post Graduate Institute of Medical Education and Research (PGIMER)

Applied Health Economics and Health Policy, 2024, vol. 22, issue 4, No 11, 569-582

Abstract: Abstract Background Survival outcomes for multiple myeloma have improved dramatically since the introduction of novel therapeutic agents. While these drugs are highly effective in improving survival outcomes and quality of life in patients with multiple myeloma, they come at a significant cost. We assessed the cost-effectiveness of bortezomib-based triplet or quadruplet drug regimens in isolation and followed by autologous hematopoietic stem cell transplantation (AHSCT) for the treatment of newly diagnosed multiple myeloma (NDMM) in the Indian context. Methods A Markov model was developed to assess the health and economic outcomes of novel drug regimens with and without AHSCT for the treatment of NDMM in India. We estimated the lifetime quality-adjusted life-years (QALYs) and costs in each scenario. The incremental cost-effectiveness ratios (ICERs) were computed and compared against the current willingness-to-pay threshold of a one-time per capita gross domestic product of ₹146,890 (US$1,927.70) for India. Parameter uncertainty was assessed through Monte Carlo probabilistic sensitivity analysis. Results Among seven treatment sequences, the VCd (bortezomib, cyclophosphamide, dexamethasone) alone arm has the lowest cost and health benefits as compared to four treatment sequences, namely VTd (bortezomib, thalidomide, dexamethasone) alone, VRd (bortezomib, lenalidomide, dexamethasone) alone, VRd plus AHSCT and DVRd (Daratumumab, bortezomib, lenalidomide, dexamethasone) plus AHSCT. It was found that VTd plus AHSCT and VCd plus AHSCT arms were extendedly dominated (ED) by combination of two alternative treatments. Among the five non-dominated strategies, VRd has a lowest incremental cost of ₹ 2,20,093 (US$2,888) per QALY gained compared to VTd alone followed by VRd plus AHSCT [₹3,14,530 (US$4,128) per QALY gained] in comparison to VRd alone. None of the novel treatment sequences were found to be cost-effective at the current WTP threshold of ₹1,46,890 (US$1,927.7). Conclusion At the current WTP threshold of one-time per capita GDP (₹ 146,890) of India, VRd alone and VRd plus AHSCT has 38.1% and 6.9% probability to be cost-effective, respectively. Reduction in current reimbursement rates of novel drugs, namely VRd, lenalidomide, and pomalidomide plus dexamethasone under national insurance program and societal cost of transplant by 50%, would make VRd plus AHSCT and VTd plus AHSCT cost-effective at an incremental cost of ₹40,671 (US$34) and ₹97,639 (US$1,281) per QALY gained, respectively.

Date: 2024
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DOI: 10.1007/s40258-024-00877-1

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