OBJECTIVES

: Survival of multiple myeloma (MM) patients has increased in recent years; however, most patients still relapse, thus, additional treatment options are essential (Nijhof et al., 2018). Newer therapies such as daratumumab, ixazomib, and pomalidomide, in combination with dexamethasone and bortezomib or lenalidomide, are efficacious but also expensive. Objectives were to analyse the differences between NICE, SMC, HAS, G-BA, PBAC, and CADTH HTA recommendations for relapsed and refractory MM (RRMM) treatments and the key drivers of decisions.

METHODS

: The SIRIUS Oncology HTA Database was used to identify NICE, SMC, HAS, G-BA, PBAC, and CADTH HTAs for 2^nd, 3^rd, or 4^th-line RRMM treatment options.

RESULTS

: HTAs were identified for nine treatment combinations (2010-2019). Thirty submissions resulted in positive recommendations, two were in progress at time of abstract submission, five were not recommended, and no company submission had been made in 12 instances.

Eight were positive in Germany; added benefit ranged from minor to considerable. Eight were positive in France, however, six received an ASMR of IV or V (no or minor improvement). Three NICE HTAs received positive outcomes, with three recommended under the CDF. Four were positive in Canada and Scotland. Only two were positive in Australia.

The five negative recommendations were because of uncertainty around clinical outcomes, either due to data immaturity or criticism of single-arm studies with non-adjusted comparisons; in three, cost-effectiveness ratios were also noted as a key driver of the negative recommendation.

In the cases of terminated appraisals, companies did not state the reason, except for elotuzumab whereby the manufacturer did not intend to seek UK reimbursement due to cost-effectiveness thresholds.

CONCLUSIONS

: In each of the scope countries, RRMM patients have access to at least three reimbursed treatments. However, despite regulatory approval being granted for efficacious treatments, there is unequal access across countries, reducing the number of options for relapsing patients.