Does Cost Limit the Value of First-Line Daratumumab For Myeloma?

First-line daratumumab therapy for patients with transplant-ineligible multiple myeloma (MM) may not be cost-effective at the drug’s current price, according to a new study.

Daratumumab is an anti-CD38 monoclonal antibody approved for the treatment of MM. Previous studies have shown that the addition of daratumumab to the combination of lenalidomide and dexamethasone (DRd) significantly prolonged progression-free survival (PFS) in newly diagnosed patients. However, daratumumab is infused indefinitely until disease progression, so at a cost of more than $6,000 per infusion, its value in a clinical setting may be limited.

For this study, researchers from the Yale University School of Medicine and the University of Alabama sought to measure the cost-effectiveness of daratumumab as a first-line therapy for transplant-ineligible patients compared with reserving its use for a second-line regimen.

To assess this, the team used a Markov model to compare healthcare costs and clinical outcomes of patients treated with first- versus second-line daratumumab. They calculated lifetime direct healthcare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERS) for these two patient groups.

The data showed that first-line daratumumab led to an improvement of 0.52 QALYs and 0.66 discounted life-years compared with second-line therapy. Both treatment strategies were associated with high lifetime costs: $1,434,937 vs. $1,112,101 US dollars for first- and second-line, respectively. At a willingness-to-pay threshold of $150,000 per QALY, the cost of first-line daratumumab would need to be 67% lower to be cost-effective.

In conclusion, the researchers wrote, “Delaying daratumumab until subsequent lines of therapy may be a reasonable strategy to limit healthcare costs without significantly compromising clinical outcomes. Mature overall survival data are necessary to more fully evaluate cost-effectiveness in this setting.”

This study was published in the Journal of Clinical Oncology.