Presentation (CTI)

OBJECTIVES: Bortezomib has been included in the Thai National List of Essential Medicines (NLEM) for transplant-eligible patients with multiple myeloma since 2023 and remains a key component of frontline treatment recommendations. However, for newly diagnosed multiple myeloma (NDMM) patients not eligible for transplantation, bortezomib-based regimens have not yet been included in the NLEM despite being recommended in clinical practice guidelines. This study aimed to conduct horizon scanning and stakeholder engagement to identify clinically relevant treatment options and define policy-relevant scope of the economic evaluation (EE) for transplant-ineligible NDMM patients in Thailand.
METHODS: Horizon scanning included reviews of clinical practice guidelines, published literature, and policy information related to treatment options for transplant-ineligible NDMM patients. Stakeholder consultations involving clinicians, policy stakeholders, and researchers were conducted to identify key policy questions and determine EE's scope. Information identified through horizon scanning was mapped with stakeholders' opinions to support future health economic modeling, including clinical effectiveness, safety, health-related quality of life, treatment costs, adverse event management costs, and disease progression costs.
RESULTS: Stakeholders highlighted a policy gap between guideline recommendations and treatment access in Thailand. Although the project was initially focused on bortezomib (8 regimens), the scope was broadened to include targeted therapies (7 regimens) recommended in clinical practice guidelines. Scope elements included transplant-ineligible NDMM patients as the target population, bortezomib-based and other guideline-recommended targeted therapies as interventions, and melphalan-prednisone, currently included in the NLEM, as the primary comparator. Outcomes included progression-free survival, overall survival, adverse events, health-related quality of life, and costs. A lifetime time horizon and societal perspective were identified. These findings supported the transition toward broader treatment landscape evaluation for reimbursement consideration in Thailand.
CONCLUSIONS: Horizon scanning and stakeholder engagement demonstrate a role in supporting policy-relevant prioritization of treatment options and help define EE scope to inform reimbursement decision-making for transplant-ineligible NDMM patients in Thailand.