First-Line Daratumumab Is Cost-Effective for Transplant-Eligible MM

An economic analysis has indicated that adding daratumumab to first-line lenalidomide, bortezomib, and dexamethasone (RVd) and thalidomide, bortezomib, and dexamethasone (VTd) regimens for transplant-eligible multiple myeloma (MM) is cost-effective, given that outcomes are improved and overall costs are reduced. According to study researchers, the delay of costly second-line treatment appears to be the key to this cost-effectiveness.

According to this study, the addition of daratumumab to these regimens in the GRIFFIN and CASSIOPEIA trial, respectively, showed improved rates of minimal residual disease (MRD) negativity. Here, the researchers conducted a cost-effectiveness analysis with a 10-year time horizon to compare first- and second-line daratumumab for transplant-eligible patients with newly diagnosed MM.

The researchers developed a Markov model that uses MRD status to predict progression-free survival (PFS).

Both daratumumab plus RVd and daratumumab plus VTd showed higher quality-adjusted life years (QALYs) with lower costs at 120 months compared with either regimen alone, “meaning that first-line was dominant compared to second-line daratumumab regardless of the willingness to pay threshold,” the researchers wrote.

“First-line use of daratumumab dominated second-line use of daratumumab with higher QALY and higher costs at the start but lower costs overall,” they wrote.

Daratumumab with RVd in the first-line setting showed higher QALYs (5.43 vs 5.18) and lower costs compared with RVd alone (U.S. $956,037 vs $1,066,585). Daratumumab with VTd in the second-line setting showed higher QALYs (5.67 vs 5.42) and lower costs (U.S. $673,919 vs $746,903) compared with VTd alone.

The researchers noted several limitations of the study, including the assumption by the model that all patients received uniform treatment, that PFS was defined by MRD status regardless of the contents or duration of maintenance therapy, and that individual patient characteristics such as cytogenetic abnormalities were not considered.

Yamamoto C, Minakata D, Koyama S, et al. Daratumumab in first-line is cost-effective in transplant-eligible newly diagnosed myeloma patients. Blood. 2022. doi:10.1182/blood.2021015220