High Costs of Daratumumab Quadruplet Therapy for Transplant-Ineligible MM

A study published in Frontiers of Pharmacology evaluated the cost-effectiveness of adding daratumumab (D) to the combination regimen of bortezomib, melphalan, and prednisone (VMP) for the treatment of transplant-ineligible, newly diagnosed multiple myeloma (MM).

“D-VMP conferred patients with substantial improvement in health outcomes, but its cost was much higher than VMP. Therefore, we did this study to evaluate the cost-effectiveness of D-VMP and VMP to treat transplant-ineligible, newly diagnosed [patients with MM] from the perspective of U.S. payers,” explained the authors. According to the authors, this was the first study of cost-effectiveness of daratumumab-based regimens in this patient population.

In total, 706 patients were included in the analysis, including 350 patients treated with daratumumab plus VMP and 356 patients treated with VMP alone. The investigators conducted a three-state Markov model to simulate disease development, with primary outcomes of total costs, expected life-years, quality-adjusted life years, and incremental cost-effectiveness ratios. Costs included in the analysis included direct medical care costs, such as drugs, evaluation and management, as well as treatment costs of adverse events.

Based on the model, the addition of daratumumab to VMP led to an additional 3 life-years and 2.03 quality-adjusted life-years. The average cost per additional life-year was $262,526, and $388,364 per quality-adjusted life-year.

“From the perspective of US payers and based on $150,000 as a willingness to pay threshold, adding daratumumab to bortezomib, melphalan and prednisone for untreated multiple myeloma was estimated not to be cost-effective,” wrote the study authors in conclusion.