OBJECTIVES: Adding daratumumab (DARA) to bortezomid and dexamethasone (Vd) provides a superior benefit of progression-free survival (PFS) for patients with relapsed or refractory multiple myeloma (RRMM). However, it is still unclear whether the addition of DARA is cost-effective for RRMM. Based on the latest updated analysis of clinical trial, this study performed an economic evaluation of the addition of DARA to Vd for patients with RRMM.

METHODS: A decision Markov model was used to estimate the long-term costs and effectiveness. A US-payers perspective, a lifetime horizon and a half-cycle correction were used to estimate the total costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). A series of sensitivity analyses were performed to address the model robustness. Variations in the price of DARA and subgroup analysis were conducted.

RESULTS: The base-case analysis showed that adding DARA to Vd provided an addition 1.256 QALYs (1.645 LYs), with incremental $213,164 ($163,184) per QALY (LY) gained. Univariable sensitivity analyses suggested that the subsequent treatment cost for DVd and the price of daratumumab impacted utmost on the ICER. According to the variations analysis of DARA price, the addition of DARA would be cost-effective when DARA was priced at 70% (30%) of the current price at a willingness-to-pay threshold of $200,000/QALY ($150,000/QALY). Subgroup analysis indicated that adding DARA to Vd was the most cost-effective in patients with 1 prior line of therapy.

CONCLUSIONS: From a US-payers perspective, daratumumab adding to bortezomib and dexamethasone in RRMM exceeds the common accepted values of cost-effectiveness.