EARLY PHASE ECONOMIC EVALUATION OF NEW GENERATION SEQUENCE DIAGNOSTICS IN MULTIPLE MYELOMA
Author(s)
Kalo Z1, Valyi-Nagy I2, Szekely A3, Szikora B4, Bendes R5, Varga G5, Szilberhorn L6, Nagy B1, Mikala G2, Kacskovics I4
11) Semmelweis University; 2) Syreon Research Institute, Budapest, PE, Hungary, 2South Pest Central Hospital – National Institute for Hematology and Infectious Diseases, Budapest, Hungary, 3Syreon Research Romania, Tirgu Mures, Romania, 4Eötvös Loránd University, Budapest, Hungary, 5Syreon Research Institute, Budapest, PE, Hungary, 61) Eötvös Loránd University; 2) Syreon Research Institute, Budapest, PE, Hungary
Presentation Documents
OBJECTIVES In multiple myeloma new generation sequence (NGS) diagnostics has the potential to accurately detect minimal residual disease. Consequently, patients following stem cell transplantation may avoid unnecessary and expensive maintenance therapy due to the fear of minimal residual disease in case of two negative NGS test results. Our goal was to develop a model assessing the economic value potential of an NGS diagnostics in development compared to no further diagnostics in multiple myeloma. METHODS Decision tree was used to allocate patients according to diagnosis, followed by a Markov model simulating the overall and progression free survival of patients using 28-day long cycles over 10-year time horizon. Patients with positive diagnosis stayed on maintenance therapy, negatively diagnosed patients stopped treatment. It was assumed that false negative patients terminate effective therapy, which results in worse prognosis for these subjects. For NGS diagnostics 98.1% specificity and 99.5% sensitivity were assumed. Costs and utilities for a US population were estimated based on the literature. Net Monetary Benefit (NMB) was calculated with a 150 thousand USD cost/QALY threshold. RESULTS Due to NGS diagnostics, 58.9% of patients were predicted to stop therapy as being true negative and 0.2% as being false negative. On the comparator arm, all patients stayed on maintenance therapy according to the current treatment practice. At zero price, inclusion of NGS into the diagnostic protocol would accumulate 32.8 thousand USD NMB. The model was highly sensitive to the prevalence of positive patients in the population, the diagnostic accuracy of NGS and the compliance of physicians with test results. CONCLUSIONS NGS may generate significant cost-savings in multiple myeloma by confirming the appropriateness of therapy discontinuation for patients in full remission. Scenario analyses could explore the economic value of other diagnostic protocols with special focus on time difference between two negative test results.
Conference/Value in Health Info
2020-05, ISPOR 2020, Orlando, FL, USA
Value in Health, Volume 23, Issue 5, S1 (May 2020)
Code
PPM6
Topic
Economic Evaluation, Medical Technologies
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Diagnostics & Imaging
Disease
Oncology