Uyl-de Groot Carin A, Ramsden Rachel, Lee Dawn, Boersma Janneke, Zweegman Sonja, Dhanasiri Sujith
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
BresMed Health Solutions, Sheffield, UK.
Eur J Haematol. 2020 Nov;105(5):635-645. doi: 10.1111/ejh.13497. Epub 2020 Sep 12.
Autologous stem cell transplantation (ASCT) has improved progression-free survival (PFS) and overall survival in eligible patients with newly diagnosed multiple myeloma (NDMM); however, relapse occurs. Maintenance therapy with lenalidomide (Len-Mt) extends survival and delays relapse and the subsequent initiation of costly second-line regimens. Here, we report the cost-effectiveness of Len-Mt following ASCT from a Dutch healthcare service perspective.
A partitioned survival model was developed to assess the lifetime costs and benefits for patients with NDMM. Efficacy was taken from a pooled meta-analysis of clinical trial data. Costs and subsequent therapy data were taken from sources appropriate for the Dutch market.
Lenalidomide produced a quality-adjusted life year gain of 2.46 and a life year gain of 2.79 vs no maintenance treatment. The cost of lenalidomide was partially offset by savings of EUR 77 462 in subsequent treatment costs. The incremental cost-effectiveness ratio of Len-Mt vs no maintenance treatment was EUR 30 143. Key model drivers included subsequent therapies, dosing schedule, and time horizon.
Lenalidomide is cost-effective after ASCT vs no maintenance therapy in the Netherlands. By extending PFS, lenalidomide delays the cost burdens associated with relapse and subsequent treatment lines.
自体干细胞移植（ASCT）改善了新诊断的多发性骨髓瘤（NDMM）合格患者的无进展生存期（PFS）和总生存期；然而，复发仍会发生。来那度胺维持治疗（Len-Mt）可延长生存期、延迟复发以及后续昂贵二线治疗方案的启动。在此，我们从荷兰医疗服务角度报告ASCT后Len-Mt的成本效益。
建立一个分割生存模型来评估NDMM患者的终身成本和效益。疗效数据取自临床试验数据的汇总荟萃分析。成本和后续治疗数据取自适合荷兰市场的来源。
与不进行维持治疗相比，来那度胺产生了2.46个质量调整生命年的增益和2.79个生命年的增益。来那度胺的成本被后续治疗成本节省的77462欧元部分抵消。Len-Mt与不进行维持治疗相比的增量成本效益比为30143欧元。关键模型驱动因素包括后续治疗、给药方案和时间范围。
在荷兰，与不进行维持治疗相比，ASCT后使用来那度胺具有成本效益。通过延长PFS，来那度胺延迟了与复发及后续治疗线相关的成本负担。
