Custo-efetividade do esquema com daratumumabe, bortezomibe e dexametasona em comparação com terapias à base de carfilzomibe, elotuzumabe e ixazomibe para o tratamento de mieloma múltiplo recidivado e refratário na perspectiva de um pagador do sistema

Abstract

Objective: To estimate the incremental cost-effectiveness ratio of daratumumab, bortezomib, and dexamethasone (DVd) combination in comparison to carfilzomib and dexamethasone (Kd); carfilzomib, lenalidomide and dexamethasone (KRd); elotuzumab, lenalidomide and dexamethasone (ERd); and ixazomib, lenalidomide and dexamethasone (IRd) for the treatment of patients with relapsed and refractory multiple myeloma (RRMM) from a Brazilian private payer perspective. Methods: It was used a three-health state transition model based on the area under the curve method to simulate the cohort trajectory: pre-progression, post-progression, and death. Clinical parameters were obtained in a meta-analysis and considered costs were: drugs acquisition and administration, and medical services. Time-horizon was 30 years, and discount rates applied to costs and outcomes were 5%. A probabilistic sensitivity analysis was performed to evaluate the impact of the uncertainty of the input values. Results: The analysis demonstrated that DVd treatment is dominant over Kd, KRd, ERd, and IRd, providing an increment of 1.09 life year with cost reduction of R$174.227 when compared to Kd, an increment of 0,15 life year with cost reduction of R$238.324 when compared to KRd, an increment of 0,06 life year with cost reduction of R$641.021 when compared to ERd, and an increment of 0,59 life year with cost reduction of R$254.367 when compared to IRd. The probabilistic sensitivity analysis confirms the robustness of the model and results consistency, demonstrating that DVd has 92.9%, 89.1%, 99.9%, and 94,2% probability of being cost-effective versus Kd, KRd, Erd, and IRd, respectively, when an ICER of 3 per-capita GDP is assumed. Conclusion: DVd combination demonstrated superior clinical and economic outcomes in RRMM patients when compared to Kd, KRd, Erd, and IRd, since the therapy provides longer survival to patients at a lower cost to payers.