INTRODUCTION: Current available treatments for multiple myeloma (MM) are associated with toxicity issues which increase treatment and patient burden. The high frequency of administration of parenteral agents, coupled with the complexity of oral+parenteral combination treatment regimens adds to patient, caregiver and health system burden. New agents to combine with lenalidomide-dexamethasone, such as carfilzomib are highly care-intensive. The availability of an all-oral treatment option, such as ixazomib (Ninlaro^®) can help relieve this burden.

OBJECTIVES: To identify and quantify the cost of the health care resources related to the use of ixazomib and its comparators in the treatment of MM in Quebec, Canada.

METHODS: A net cost impact model was developed to provide a detailed analysis of the cost implications of ixazomib-lenalidomide-dexamethasone (ILd) utilization compared with lenalidomide- dexamethasone (Ld) and carfilzomib-lenalidomide-dexamethasone (CLd), including the drug treatment costs, costs related to the preparation and administration of medications, and monitoring costs. Expert consultation with physicians, pharmacists and nurses in Quebec were used to define treatment algorithms including all health resource utilization required when using ILd, Ld, and CLd.

RESULTS: The treatment cost of ixazomib (4mg administered orally once a week on Days 1, 8 and 15 of a 28-day treatment cycle), in combination with lenalidomide (25mg daily on days 1-21) and dexamethasone (40 mg on days 1, 8, 15 and 22) was $307,514. The treatment costs for Ld and CLd were $136,388 and $348,093, respectively. Given ILd and Ld are all oral treatments, there were no costs related to the preparation and administration. However, $5,118 was attributed to CLd. The cost of monitoring was greatest with CLd ($2,473) compared with ILd ($1,361) and Ld ($1,240).

CONCLUSIONS: Patients receiving ILd could save the Quebec health care system $46,809 compared with CLd.