OBJECTIVES: Momelotinib is a newly approved Janus kinase inhibitor (JAKi) that can provide substantial spleen, symptom, and anemia benefits for patients with myelofibrosis, but the value associated with its use vs other treatment options is unclear. We developed a cost-effectiveness model to estimate total costs and quality-adjusted life-years (QALYs) of momelotinib vs pacritinib or vs best available therapy (BAT; as observed in the phase 3 SIMPLIFY-2 trial), current standard-of-care treatment options in JAKi-experienced patients.

METHODS: A Markov model compared costs (2023 US $) and QALYs over a 30-year time horizon in US adults with intermediate- or high-risk myelofibrosis with anemia (hemoglobin [Hb] <10 g/dL) who were JAKi experienced in relevant phase 3 trials. Health states were defined as transfusion independent (TI; no red blood cell [RBC] transfusions and Hb >8 g/dL in the prior 12 weeks), transfusion dependent (TD; ≥4 RBC units or Hb <8 g/dL in the prior 8 weeks), transfusion requiring (not TI/TD), and death; transition probabilities were estimated from SIMPLIFY-2, with pacritinib assumed equal to BAT as data specific to pacritinib were unavailable. Costs included drug acquisition/administration, subsequent treatment (assumed to be BAT), adverse events, monitoring, transfusions, and terminal care. Utility values were calculated from EQ-5D-5L responses (US value set) in SIMPLIFY-2 (pacritinib assumed equal to momelotinib). Sensitivity analyses assessed robustness of results to input changes.

RESULTS: Total costs (QALYs) were $577,476 (2.21), $730,762 (2.07), and $870,696 (2.11) for momelotinib, BAT, and pacritinib, respectively. Momelotinib was preferred vs BAT in terms of costs ($153,286 savings) and QALYs (0.14 more); pacritinib was costlier than BAT ($139,934 increase) but increased QALYs (by 0.04). Results were most sensitive to overall survival in the TD state, followed by the proportion of patients on BAT receiving ruxolitinib.

CONCLUSIONS: These results suggest that momelotinib is cost-effective for treating myelofibrosis in JAKi-experienced populations.