Aceituno Susana, Gozalbo Irmina, Appierto Marilena, Lizán Luis
Outcomes10, S.L., Castellón de la Plana, España. Address: Avenida Vicente Sos Baynat, s/n, Castellón de la Plana, España, CP: 12071. Email:
Outcomes10, S.L., Castellón de la Plana, España.
Medwave. 2018 Jun 29;18(3):e7220. doi: 10.5867/medwave.2018.03.7220.
Multiple myeloma is a hematologic malignancy affecting bone marrow derived plasma cells. Current therapies are not able to eradicate the disease and most patients become refractory to the treatment. Lenalidomide and bortezomib have proved effective in the second-line treatment of these patients.
To evaluate the cost-effectiveness of lenalidomide in combination with dexamethasone compared to bortezomib in combination with dexamethasone in patients with multiple myeloma previously treated with bortezomib, from the perspective of the Chilean National Health Service.
A four-state Markov model (preprogression on treatment; preprogression off treatment, progression and death) was used to simulate the evolution of a cohort of multiple myeloma patients over a 25-year time horizon. Efficacy data, resource use and frequency of adverse events were extracted from MM009/010 studies and a retrospective analysis of retreatment with bortezomib. All inputs were validated by experts. A 3% annual discount rate was used for costs and health outcomes. The robustness of the results was evaluated through univariate and probabilistic sensitivity analyses.
Lenalidomide in combination with dexamethasone treatment provided 1.41 incremental life years and 0.83 incremental quality-adjusted life years in comparison with bortezomib in combination with dexamethasone, with an incremental cost of 11 864 597.86 CLP (19 589.86 US$). The incremental cost-effectiveness and cost-utility ratio were estimated at 8 410 266.92 CLP (13 886,35 US$) / incremental life year and 14 271 896.16 CLP (23 564,59 US$)/incremental quality-adjusted life years, respectively.
Lenalidomide in combination with dexamethasone represents a potentially cost-effective alternative for the second-line treatment of patients with multiple myeloma who are not eligible for transplantation, from the perspective of the Chilean National Health Service.
多发性骨髓瘤是一种影响骨髓来源浆细胞的血液系统恶性肿瘤。目前的治疗方法无法根除该疾病，大多数患者会对治疗产生耐药性。来那度胺和硼替佐米已被证明在这些患者的二线治疗中有效。
从智利国家卫生服务的角度，评估与硼替佐米联合地塞米松相比，来那度胺联合地塞米松治疗既往接受过硼替佐米治疗的多发性骨髓瘤患者的成本效益。
采用四状态马尔可夫模型（治疗中疾病未进展；治疗中断疾病未进展、疾病进展和死亡）来模拟一组多发性骨髓瘤患者在25年时间范围内的病情演变。疗效数据、资源使用情况和不良事件发生频率取自MM009/010研究以及硼替佐米再治疗的回顾性分析。所有数据输入均经专家验证。成本和健康结果采用3%的年贴现率。通过单因素和概率敏感性分析评估结果的稳健性。
与硼替佐米联合地塞米松相比，来那度胺联合地塞米松治疗可增加1.41个生命年和0.83个质量调整生命年，增量成本为11864597.86智利比索（19589.86美元）。增量成本效益比和成本效用比分别估计为8410266.92智利比索（13886.35美元）/增量生命年和14271896.16智利比索（23564.59美元）/增量质量调整生命年。
从来那度胺联合地塞米松治疗的角度来看，对于不符合移植条件的多发性骨髓瘤患者的二线治疗，来那度胺联合地塞米松可能是一种具有成本效益的替代方案。
