Economic Evaluation and Budget Impact of RVd as Induction Regimen Prior to ASCT in Patients with Newly Diagnosed Multiple Myeloma from the Perspective of the Public Health Sector in Mexico

OBJECTIVES: Compare the costs effectiveness of RVd (lenalidomide, bortezomib and dexamethasone) and D-VTd (daratumumab, bortezomib, thalidomide and dexamethasone) as induction regimen prior to autologous stem cell transplantation (ASCT) and estimate the budget impact associated with the use of RVd in this indication, from the perspective of the public health sector in Mexico.

METHODS: Cost minimization evaluating very good partial or superior response (≥VGPR) was performed. This measure of effectiveness is associated with long-term outcomes and is valuable in the clinical setting for therapeutic decision-making. In all the analyzes performed, the difference in the rates of patients with ≥VGPR between RVd and D-VTd was very small and not statistically significant.

RESULTS: The cost per patient was 46.1% lower with RVd vs. D-VTd regimen ($528,916 vs. $981,219). The difference is mainly due to savings in acquisition costs, the amount of which was calculated at almost $450,000 MXN per patient in favor of the use of RVd. The budget impact analysis showed net savings in favor of RVd for $18.35 million MXN in the first year (41 patients) and $285.5 million MXN accumulatively from 2022 to 2026 (631 patients).

CONCLUSIONS: The use of lenalidomide in combination therapy with bortezomib and dexamethasone as an induction regimen prior to ASCT constitutes a cost-saving intervention compared to the use of daratumumab in combination with bortezomib, thalidomide and dexamethasone.