OBJECTIVES: To determine the cost-effectiveness of XVd in previously treated MM.

METHODS: The phase III BOSTON trial of once weekly XVd versus twice weekly bortezomib and dexamethasone (Vd) was the basis for this cost-effectiveness analysis (CEA) from a US commercial payer perspective. Comparators to XVd included daratumumab/pomalidomide/dexamethasone (DPd), daratumumab/lenalidomide/dexamethasone (DRd), lenalidomide/dexamethasone (Rd), pomalidomide/bortezomib/dexamethasone (PVd), elotuzumab/pomalidomide/dexamethasone (EPd), carfilzomib/pomalidomide/dexamethasone (KPd), and daratumumab/bortezomib/dexamethasone (DVd). A partitioned survival model enabled the use of direct overall survival (OS) and progression-free survival (PFS) curves from BOSTON to generate four health states for XVd and Vd: PFS on treatment, PFS off treatment, post-progression, and mortality. Using a one-week cycle length, benefits and costs were discounted at 3.0% annually. Cost inputs included primary therapy and administration, secondary therapy, routine medical care, treatment-related adverse events, and mortality. Utility values were obtained from the literature using EQ-5D-5L data. Clinical outcomes for the comparators were based on results from a network meta-analysis.

RESULTS: For XVd versus Vd, the base case incremental cost (∆ cost) was $158,368 and the base case incremental cost-effectiveness ratio (ICER) was $471,886/quality-adjusted life year (QALY). The 50% cost-effectiveness probability midpoint was near $470,000/QALY, based on probabilistic sensitivity analysis. XVd showed a higher QALY gain with a lower cost (i.e. was dominant) compared with Rd (∆ cost: $-41,693; ICER: $-70,606/QALY), PVd (∆ cost: $-79,453; ICER: $-5,154,447/QALY), and KPd (∆ cost: $-81,834; ICER: $-59,269/QALY). XVd had lower cost and lower benefit compared with DPd (∆ cost: $-417,591; ICER: $147,482/QALY), DRd (∆ cost: $-974,308; ICER: $345,974/QALY), EPd (∆ cost: $-272,189; ICER: $465,716/QALY), and DVd (∆ cost: $-59,894; ICER: $11,367/QALY).

CONCLUSIONS: The addition of XVd to the previously treated MM triplet regimen landscape provides a novel, oral treatment option that either was cost-effective (versus Vd, DPd, and DVd) at a willingness-to-pay threshold of $150,000, or dominant (versus Rd, PVd, and KPd).