Presentation (CTI)

OBJECTIVES: Multiple myeloma affects approximately 36,000 Americans annually. The DETERMINATION trial demonstrated improved progression-free survival with early autologous stem cell transplantation (ASCT) but no overall survival benefit. The cost-effectiveness of early ASCT given substantial upfront costs without survival advantage remains unclear.
To evaluate the cost-effectiveness of early ASCT (RVD+ASCT) versus delayed/no transplant (RVD-alone) in newly diagnosed multiple myeloma from a U.S. payer perspective.
METHODS: We developed a partition survival model using digitized DETERMINATION trial data, a 50-year lifetime horizon, and monthly cycles. Lognormal distributions fitted extrapolated survival curves. Costs and utilities were applied by treatment phase. We conducted deterministic and probabilistic sensitivity analyses with 3% annual discounting.
RESULTS: RVD alone resulted in $4,911,842 costs and 7.92 QALYs while RVD+ASCT resulted in $3,833,540 costs and 8.70 QALYs. Early ASCT dominated, providing 0.78 additional QALYs while reducing costs by $1,078,302. Maintenance utility and overall survival parameters were most influential. Upfront ASCT costs had minimal impact. Early ASCT was cost-effective in 73% of iterations across all willingness-to-pay thresholds ($0-$300,000/QALY), indicating dominance in most simulations.
CONCLUSIONS: Early autologous transplantation is cost-effective for transplant-eligible multiple myeloma patients, providing improved outcomes at lower cost. Results support current clinical guideline recommendations. Extended progression-free survival and reduced salvage therapy needs offset upfront transplant costs.