OBJECTIVES: Measurable residual disease (MRD) testing has been added to the response evaluation criteria for MM, with new technologies demonstrating the ability to detect malignant cells at a level of at least 1 in 100,000. MRD status has been shown to correlate with health outcomes. NGS MRD testing can help to identify patients for consolidation treatment alone (MRD-) or stem cell transplant (SCT; MRD+). Our objective was to evaluate the potential cost savings of next-generation sequencing (NGS MRD, clonoSEQ®) incorporated into this clinical setting.

METHODS: We developed a hybrid decision tree/Markov model for NGS MRD testing compared to no testing. With testing, MRD- patients received six weeks of consolidation and MRD+ patients received SCT plus consolidation. No testing patients received SCT plus consolidation. After consolidation, patients entered a 4-state Markov model (on/off maintenance treatment, relapsed, dead). Overall survival was assumed to be the same pre-relapse based on the IFM clinical trial. Progression free survival was higher for SCT patients but was assumed to be the same for MRD+ and MRD- due to lack of data. The cost of NGS MRD was $1,800 plus $1,836 for specimen collection, SCT was $104,420, consolidation cost was $5,806/week, maintenance cost was $4,868/week, and relapse cost was $6,306/week. We used a U.S. health system perspective, a 3% discount rate, and a 3-year time horizon.

RESULTS: MRD testing saved $22,000 over three years per patient. This result was most sensitive to the percentage of patients who were MRD+ after induction treatment, the progression free survival rate for non-stem cell transplant patients, and the cost of consolidation treatment.

CONCLUSIONS: NGS MRD testing may be a cost-saving strategy compared to no MRD testing for MM patients and result in more targeted use of SCT . Additional studies are needed to better estimate health outcomes for NGS MRD testing.