OBJECTIVES With the approval of Daratumumab by the China National Medical Product Administration in 2019, this study aims to compare the cost-effectiveness of Ixazomib plus lenalidomide-dexamethasone (IRd) with Daratumumab plus lenalidomide-dexamethasone (DRd) among previously treated multiple myeloma patients in China.

METHODS A partition survival model with three health states (progression-free survival, post-progression and death) was constructed from a societal perspective in China. The relative effectiveness of comparators was derived from a network meta-analysis synthesizing results of TOURMALINE-MM1 trial and POLLUX trial due to the lack of head-to-head trial data. Both direct (drug and administration, lab testing, health resource utilization, adverse event management and post-progression treatment) and indirect costs were considered in the analysis. Data inputs were obtained from published literature and clinical experts’ interviews. Cost and effectiveness were discounted at 5% and a half-cycle correction was applied. Primary model outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICERs). One way and probabilistic sensitivity analyses (PSA) were performed to assess the robustness of the model estimates.

RESULTS In the base case of a lifetime horizon, our estimation showed that to achieve a 0.561 QALY gain from IRd (3.429 QALYs) to DRd (3.990 QALYs), an additional CNY 521,318 is required, which can be translated into an ICER of CNY 930,047/QALY for DRd versus IRd. Model results were sensitive to the hazard ratio of IRd and DRd compared with lenalidomide-dexamethasone in overall survival from the NMA results. PSA further demonstrated that DRd did not show a significant advantage over IRd, assuming a willingness to pay threshold of CNY 212,676 (triple GDP per capita in China in 2019).

CONCLUSIONS Compared to IRd, DRd is not considered as a cost-effective treatment under current prices from a societal perspective among previously treated multiple myeloma patients in China.