OBJECTIVES: To estimate treatment costs for novel triple-combination therapies in the management of relapsed/refractory multiple myeloma (RRMM) patients from the Brazilian private healthcare perspective.

METHODS: Treatment costs associated with lenalidomide+dexamethasone combinations with carfilzomib (KRd), daratumumab (DRd) and elotuzumab (ERd) were compared. For each therapy, treatment duration was estimated as the mean progression-free survival (PFS) time until three years using published PFS data from pivotal trials available for these treatments for three years follow-up. Treatment costs were estimated for the modeled treatment duration considering therapy-specific dosing schedules. Drug prices were based on May 2018 Brazilian list prices. No vial sharing was assumed. Total treatment costs, average cost per cycle, and cost per overall response rate (ORR) over the three-year period were compared.

RESULTS: Modeled treatment duration over the three-year period was 23.3, 26.4, and 20.3 months for KRd, DRd, and ERd, respectively. Corresponding average total treatment costs were estimated to be 926,448 Brazilian Real (BRL) for KRd, 1,383,596 BRL for DRd (+49% versus KRd), and 1,150,258 BRL for ERd (+24% versus KRd). KRd had the lowest average cost per cycle among the therapies, 36,654 BRL versus 48,161 BRL for DRd (+31% versus KRd) and 52,241 BRL for ERd (+43% versus KRd). Similarly, the cost per achieved ORR was lower for KRd (1,063,660 BRL) than that for DRd (1,487,737 BRL) and ERd (1,456,023 BRL) by 29% and 27%, respectively.

CONCLUSIONS: Results of the present analysis indicate that KRd is associated with lower treatment costs and lower cost per ORR than DRd and ERd over a relevant three-year time horizon from the Brazilian private healthcare perspective. The results are associated with some uncertainty due to differences in trial populations, trial design (fixed duration for carfilzomib vs treatment till progression for daratumumab and elotuzumab) and because treatment duration is typically shorter than PFS.