Chihiro Yamamoto, Daisuke Minakata, Shunsuke Koyama, Kaoru Sekiguchi, Yuta Fukui, Rui Murahashi, Hirotomo Nakashima, Sae Matsuoka, Takashi Ikeda, Shin-Ichiro Kawaguchi, Yumiko Toda, Shoko Ito, Takashi Nagayama, Kento Umino, Hirofumi Nakano, Kaoru Morita, Ryoko Yamasaki, Masahiro Ashizawa, Masuzu Ueda, Kaoru Hatano, Kazuya Sato, Ken Ohmine, Shin-Ichiro Fujiwara, Yoshinobu Kanda
Blood 140(6) 594-607 2022年5月17日
Triplet regimens such as lenalidomide, bortezomib, and dexamethasone (RVd) or thalidomide, bortezomib, and dexamethasone (VTd) are standard induction therapies for transplant-eligible newly diagnosed multiple myeloma (NDMM) patients. The addition of daratumumab to RVd and VTd has been investigated in the GRIFFIN and CASSIOPEIA trials, respectively, resulting in improvement in the rate of minimal residual disease (MRD) negativity. In this study, we conducted a cost-effectiveness analysis with a 10-year time horizon to compare first-line and second-line use of daratumumab for transplant-eligible NDMM patients. Since long-term follow-up data for these clinical trials are not yet available, we developed a Markov model that uses MRD status to predict PFS. Daratumumab was used either in the first-line setting in combination with RVd or VTd, or in the second-line setting with carfilzomib plus dexamethasone (Kd). Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated from a Japanese and US payer perspective. In the Japanese analysis, D-RVd showed higher QALYs (5.43 vs 5.18) and lower costs (\ 64,479,793 vs 71,287,569) compared to RVd, and D-VTd showed higher QALYs (5.67 vs 5.42) and lower costs (\ 43,600,310 vs \ 49,471,941) compared to VTd. Similarly, the US analysis demonstrated dominance of a strategy incorporating daratumumab in first-line treatment regimens. Given that overall costs are reduced and outcomes are improved when daratumumab is used as part of a first-line regimen, the economic analysis indicates that addition of daratumumab to first-line RVd and VTd regimens is a dominant strategy compared to reserving its use for the second-line setting.