OBJECTIVES

Daratumumab intravenous (DARA-IV) is approved to treat multiple myeloma (MM). In the COLUMBA trial, daratumumab subcutaneous (DARA-SC) demonstrated comparable efficacy, fewer infusion-related reactions, and less administration time versus DARA-IV. A budget impact model evaluated the budgetary impact of replacing DARA-IV with DARA-SC over a 5-year period from the payer perspective in Sweden.

METHODS

Costs were estimated in patients from 4 mutually exclusive groups: transplant-ineligible (TIE) newly-diagnosed MM (NDMM), transplant-eligible NDMM, relapsed/refractory MM (RRMM), and RRMM with ≥3 prior lines of therapy, including a proteasome inhibitor and an immunomodulatory drug. Base case analysis considered costs of drug acquisition, drug administration, and adverse event (AE) management; indirect costs and non-medical direct costs were excluded. Assumptions included transfer of market share from DARA-IV to DARA-SC and a beneficiary population of 1 million. Sensitivity analyses were performed.

RESULTS

DARA-SC was associated with cost savings in each of the 4 groups, with savings primarily driven by lower drug administration costs. AE management costs, incremental total costs/new patient and costs/member of the beneficiary population were also reduced in each of the groups. Overall, DARA-SC reduced the total treatment budget by Swedish krona (SEK) 403,887,455 over a 5-year period, including reduction in AE management costs by SEK 7,779,630. Incremental total cost/new patient was reduced by SEK 71,057 and incremental cost/member of the beneficiary population by SEK 403.89. Deterministic sensitivity and scenario analyses were consistent with the base case. Probabilistic sensitivity analyses showed that, overall, DARA-SC was cost-saving in at least 90.5% of 1,000 replications. DARA-SC stopped being cost-saving with a 20% body weight decrease in patients with TIE NDMM and RRMM.

CONCLUSIONS

In this analysis, replacement of DARA-IV with DARA-SC for the treatment of patients with MM was associated with substantial cost savings from the payer perspective over a 5-year period.