OBJECTIVES : To perform a 1, 3, and 5-year, multiple line, cost analysis of four triplet therapies used in the treatment of relapsed or refractory multiple myeloma (rrMM) patients from the perspective of the German statutory health insurance (GKV). The analysis compared costs of therapies in the second and three subsequent treatment lines over a 1, 3, and 5-year period.

METHODS : The analysis considered triplet therapies including ixazomib plus lenalidomide plus dexamethasone (IRd), elotuzumab plus lenalidomide plus dexamethasone (ERd), daratumumab plus lenalidomide plus dexamethasone (DRd), carfilzomib plus lenalidomide plus dexamethasone (KRd). The treatment duration for each regimen was estimated from modeled parametric progression-free survival curves (digitized and derived from clinical trials) where censored patients were removed. The probability of progression after second line treatment initiation was used to inform the average post-progression therapy cost for each regimen. In the third line, three drugs were considered including daratumumab plus bortezomib plus dexamethasone (DVd), panobinostat plus bortezomib plus dexamethasone (VFd), and pomalidomide plus dexamethasone (Pd). All seven drugs were assessed in the fourth and fifth line.

RESULTS : Although the total cost across all four triplet therapies was substantial in second line, it made up about two-thirds of total costs when subsequent treatment lines were included.

CONCLUSIONS : This cost analysis can be used to help inform decision makers and payers regarding costs of triplet regimens for the treatment of rrMM. The study shows that post-progression costs for specific regimens are substantial and should not be ignored.