OBJECTIVES: Considering the large amount of recent novel therapies for refractory and relapsed multiple myeloma (RRMM) treatment, it is essential to understand treatment strategies with best clinical and economic outcomes. Besides that, an evaluation of the treatment sequences is essential to improve patients’ outcomes and clinical decision-making process. Therefore, the aim of this study is to compare progression-free survival (PFS) and cost per progression-free patient of the sequence daratumumab-bortezomib-dexamethasone (DVd) followed by lenalidomide-dexamethasone (Rd) with the sequence Rd followed by DVD in RRMM patients from Brazilian private payers perspective.

METHODS: We developed a model to estimate PFS and cost per progression-free patient of two treatment sequences after frontline failure: DVd-Rd and Rd-DVd. After extraction of PFS data from clinical trials (CASTOR for DVd and ASPIRE for Rd), we chose the best fitting curves among four standard data distributions (Weibull, log-logistic, log-normal and exponential) for PFS with 1 prior line (PFS) and 2 prior lines (PFS2) estimations. Costing parameters included drugs costs based on official listing price in Brazil and Brazilian labels of daratumumab and lenalidomide.

RESULTS: DVd followed by Rd achieved better PFS outcome. In PFS and PFS2, DVd-Rd sequence was 24% (71% vs. 48%) and 9% (87% vs. 78%) higher than Rd-DVd, respectively. Despite higher treatment cost in a two-year period, DVd-Rd had lower cost per progression-free patient compared to Rd-DVd (1.07 million BRL vs. 1.25 million BRL).

CONCLUSIONS: DVd-Rd treatment sequence demonstrated better PFS, PFS2 and cost per progression-free patient profile than Rd-DVd sequence. Confirming findings from clinical trials, we demonstrated that anticipating DVd to earlier treatment lines improves patient’s outcomes. Additionally, bringing DVd to earlier treatment line also results in economic benefits.