Objective: This study assesses the cost-effectiveness of carfilzomib plus lenalidomide and dexamethasone (KRd) versus ixazomib plus lenalidomide and dexamethasone for relapsed and refractory multiple myeloma (RRMM) in China.
Methods: A survival model was used to analyze health states and costs over a lifetime, with a 4-week cycle. Treatment effects on progression-free survival (PFS) and overall survival (OS) were modeled using hazard ratios (HRs) derived from the network meta-analysis (NMA). Health state utility values and disutility values for adverse events were obtained from published literature. Direct medical costs included drug costs, disease management costs, and costs associated with adverse event management. Costs and utilities were discounted by 5% annually. Both one-way and probabilistic sensitivity analyses were conducted.
Results: The carfilzomib combination was found to be cost-effective, saving $127,513.22 per additional quality-adjusted life year (QALY) gained compared to the ixazomib combination. Sensitivity analysis showed that ixazomib's price, progression state utility, and carfilzomib's price significantly affected the results. At a $40,023.27 willingness-to-pay (WTP) threshold, the carfilzomib combination has a 100% probability of being cost-effective.
Conclusions: The study shows that, based on evidence from indirect comparisons, KRd is a cost-effective treatment option for RRMM patients in China.
Keywords: Carfilzomib; cost-effectiveness; ixazomib; meta-analysis; multiple myeloma.
1. Why was this study conducted? Multiple myeloma (MM) is a common blood cancer for which there is currently no cure. Patients may become resistant to traditional treatments, necessitating new therapeutic approaches. Researchers wanted to determine which of two new treatment methods was more cost-effective, meaning it costs less while still providing good therapeutic outcomes.2. What did the researchers do? The researchers compared two treatment regimens: one involving carfilzomib combined with lenalidomide and dexamethasone (the KRd regimen), and the other involving ixazomib combined with lenalidomide and dexamethasone (the IRd regimen). We built a model to simulate patients’ health conditions by simplifying the clinical process and calculated the costs of treatment as well as the health benefits for patients. Additionally, we examined outcomes under different scenarios to ensure the reliability of their conclusions.3. What did the researchers find? The researchers found that the KRd regimen had a more significant economic advantage. Patients treated with the KRd regimen had lower treatment costs and lived longer with better quality of life. Even under different prices and conditions, the KRd regimen remained the better option.4. What do these findings mean? These findings mean that for MM patients, the KRd regimen is a better treatment choice. It not only saves money but also helps patients live longer and feel better. This is good news for both patients and doctors as they can choose a treatment method that is effective and affordable. It also aids in decisions regarding medical insurance and drug purchasing, as it allows for more effective allocation of funds.