Budget Impact of Selinexor Combination Regimens in Previously Treated Multiple Myeloma

OBJECTIVES: Selinexor-based combination regimens (indicated for adult patients with multiple myeloma who have received ≥1 prior therapy) are associated with improved clinical outcomes in the relapsed/refractory multiple myeloma (RRMM) setting. Patient prognosis worsens once progression occurs after exposure to an immunomodulatory drug, proteasome inhibitor, and anti-CD38 monoclonal antibody. We sought to assess the budget impact of selinexor-based combination regimens post anti-CD38 monoclonal antibody therapy in the 2nd-5th treatment line.

METHODS: A 3-year budget impact model was developed from the perspective of a hypothetical US private payer with 1,000,000 members. Scenarios with and without selinexor-based combinations and including 12 other guideline-supported non-selinexor regimens were compared. The model included incident patients with RRMM post anti-CD38 treatment. Costs (2023 US dollars) attributable to primary treatment drug acquisition and administration, adverse events, routine monitoring and medical services, post-progression treatment and medical services, and terminal care were included. Annual and cumulative total costs and incremental cost per patient per month (PPPM) and per member per month (PMPM) were assessed.

RESULTS: The 3-year cumulative costs comparing scenarios for 61 eligible patients with RRMM with and without selinexor-based combination regimens were $73,940,083 and $73,970,909, respectively (difference: -$30,826). PMPM was -$0.003 and PPPM was -$42 at 3 years. In univariate sensitivity analysis, outcomes were most sensitive to time on selinexor, selinexor combination regimen utilization, and utilization of CAR-T therapies. By model year 3, acquisition costs of selinexor-based combinations as primary therapy were offset by costs of secondary treatment received after disease progression.

CONCLUSIONS: Implementing selinexor-based combination regimens was associated with cost-savings cumulatively over 3 years due to the delay of more costly treatment options such as bispecific and CAR T therapies. Future research is warranted as the increased use of newer therapies such as bispecific and CAR-T therapies in earlier lines will change the economic paradigm in RRMM.