Cao Yaohua, Zhao Lina, Zhang Tiantian, Cao Weiling
Department of Pharmacy, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, China.
College of Pharmacy, Jinan University, Guangzhou, China.
Front Pharmacol. 2021 Mar 1;12:608685. doi: 10.3389/fphar.2021.608685. eCollection 2021.
To evaluate the cost-effectiveness of adding daratumumab to bortezomib, melphalan, and prednisone for transplant-ineligible newly diagnosed multiple myeloma patients. A three-state Markov model was developed from the perspective of US payers to simulate the disease development of patient's life time for daratumumab plus bortezomib, melphalan, and prednisone (D-VMP) and bortezomib, melphalan, and prednisone (VMP) regimens. The primary outputs were total costs, expected life-years (LYs), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). The base case results showed that adding daratumumab to VMP provided an additional 3.00 Lys or 2.03 QALYs, at a cost of $262,526 per LY or $388,364 per QALY. Sensitivity analysis indicated that the results were most sensitive to utility of progression disease of D-VMP regimens, but no matter how these parameters changed, ICERs remained higher than $150,000 per QALY. In the case that the upper limit of willingness to pay threshold was $150,000 per QALY from the perspective of US payers, D-VMP was not a cost-effective regimen compared to VMP.
为评估在硼替佐米、美法仑和泼尼松基础上加用达雷妥尤单抗治疗不适宜移植的新诊断多发性骨髓瘤患者的成本效益。从美国医保支付方的角度建立了一个三状态马尔可夫模型，以模拟达雷妥尤单抗联合硼替佐米、美法仑和泼尼松（D-VMP）方案以及硼替佐米、美法仑和泼尼松（VMP）方案患者一生的疾病发展情况。主要产出包括总成本、预期生命年（LYs）、质量调整生命年（QALYs）和增量成本效益比（ICERs）。基础病例结果显示，在VMP方案中加用达雷妥尤单抗可额外增加3.00个生命年或2.03个质量调整生命年，每生命年成本为262,526美元，每质量调整生命年成本为388,364美元。敏感性分析表明，结果对D-VMP方案疾病进展的效用最为敏感，但无论这些参数如何变化，增量成本效益比均高于每质量调整生命年150,000美元。从美国医保支付方的角度来看，若支付意愿阈值上限为每质量调整生命年150,000美元，与VMP方案相比，D-VMP方案不具有成本效益。
