OBJECTIVES: Daratumumab plus lenalidomide and dexamethasone (DRd) and carfilzomib plus lenalidomide and dexamethasone (KRd) are two regimens approved for the treatment of Relapsed/Refractory (R/R) Multiple Myeloma (MM) in Brazil and the objective of this study is to estimate and compare DRd vs KRd in number needed to treat (NNT) and cost of preventing an event (COPE).

METHODS: NNT was calculated as the inverse of the absolute risk of an event to occur in a definite time point (36 months). COPE was derived by multiplying the total treatment costs by the NNT; the lower the COPE, the more cost-efficient the intervention will be. Progression-free survival (PFS) in patients with relapsed or refractory MM after 1 previous line of therapy was used as surrogate for treatment duration. Clinical outcomes were obtained from the main clinical studies considering PFS curves from ASPIRE and POLLUX trials. Only drug costs were considered, which were based on the published ex-factory prices in 2019 (Brazilian currency - BRL) and dosing information in their respective label. The study perspective was the Brazilian Supplementary Health System.

RESULTS: The results in 36 months demonstrated the following NNT values for DRd = 3.3 compared to KRd = 18.5. Due to the greater efficiency of the triplet DRd, this combination provided the lowest number of treated patients for a case of success. In terms of COPE, the DRd combination showed the lowest cost of preventing values compared to KRd (BRL 5,934,273.58 vs BRL R$23,914,814.81).

CONCLUSIONS: Results showed that DRd leads to lower NNT and COPE results compared to KRd. In a scenario of limited resources, the COPE approach may be a useful tool to determined which drugs to reimburse.