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.

Hot off the press in JCO, cost effectiveness of frontline Daratumumab among older adults with MM. ICER $618,018 per QALY. Time for value based pricing in the US? Work led by MS3 Kishan Patel, @sfhYALE @DiMengyang https://t.co/xh3Nc9hvb1

— Smith Giri MD MHS (@smith__giri) January 8, 2021