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

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Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden. / Borg, Sixten; Nahi, Hareth; Hansson, Markus; Lee, Dawn; Elvidge, Jamie; Persson, Ulf.

I: Acta Oncologica, Vol. 55, Nr. 5, 2016, s. 554-560.

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Borg, Sixten ; Nahi, Hareth ; Hansson, Markus ; Lee, Dawn ; Elvidge, Jamie ; Persson, Ulf. / Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden. I: Acta Oncologica. 2016 ; Vol. 55, Nr. 5. s. 554-560.

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TY - JOUR

T1 - Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden

AU - Borg, Sixten

AU - Nahi, Hareth

AU - Hansson, Markus

AU - Lee, Dawn

AU - Elvidge, Jamie

AU - Persson, Ulf

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

U2 - 10.3109/0284186X.2015.1096021

DO - 10.3109/0284186X.2015.1096021

M3 - Article

VL - 55

SP - 554

EP - 560

JO - Acta Oncologica

T2 - Acta Oncologica

JF - Acta Oncologica

SN - 1651-226X

IS - 5

ER -