OBJECTIVES

: Novel therapies in refractory and relapsed multiple myeloma (RRMM) represent an important advance for disease management. Since there is limited budget for healthcare management, a rationale budget allocation in the incorporation of novel technologies is crucial. Therefore, the aim of this study is to support decision making by comparing the costs and progression-free survival (PFS) of the treatments sequence daratumumab-bortezomib-dexamethasone (DVd) followed by carfilzomib-lenalidomide-dexamethasone (KRd) with KRd followed by DVd in RRMM patients from Brazilian private payers perspective.

METHODS

: A model was developed to estimate PFS and treatment costs of two treatment sequences after frontline failure: DVd-KRd and KRd-DVd. PFS data were extracted from DVd and KRd pivotal studies, and the best fitting curves were chosen among four standard data distributions (Weibull, log-logistic, log-normal and exponential) for PFS with 1 prior line (PFS) and 2 prior lines (PFS2). Only drugs costs, which were obtained on Brazilian official listing price, were included in this analysis.

RESULTS

: DVd followed by KRd achieved better PFS outcome with decreased costs when compared to KRd-DVd sequence, in both 1- and 2-years’ time-horizon. In one and two years, DVd-KRd had costs of BRL 599,887/patient and BRL 924,359/patient, respectively, compared to BRL 862,862/patient and BRL 1,256,072/patient in KRd-DVd sequence. In two years, PFS and PFS2 for DVd-KRd sequence were, respectively, 15% (71% vs. 56) and 8% (90% vs. 82%) higher compared to KRd-DVd.

CONCLUSIONS

: As demonstrated in clinical trials, anticipating DVd to earlier treatment lines results in better clinical outcomes. Additionally, DVd-KRd sequence demonstrated to be cost-saving when compared to KRd-DVd since the first year of treatment. Therefore, bringing DVd to earlier lines results in better clinical and economic outcomes.