Icahn School of Medicine at Mount Sinai, New York, NY.
Analysis Group, Inc., Boston, MA.
J Manag Care Spec Pharm. 2023 Nov;29(11):1205-1218. doi: 10.18553/jmcp.2023.23031. Epub 2023 Sep 30.
Economic differences among currently available proteasome inhibitors (PI)-based lenalidomide-dexamethasone (Rd)-backbone triplet regimens-ixazomib (I), bortezomib (V), and carfilzomib (K) plus Rd-remain poorly understood. To assess health care resource utilization (HCRU) and health care costs of patients with relapsed/refractory multiple myeloma (RRMM) in the United States treated with IRd, VRd, and KRd. This retrospective longitudinal cohort study using IQVIA PharMetrics Plus adjudicated claims US data (January 1, 2015, to September 30, 2020) included adult patients with all available data who initiated IRd, VRd, or KRd in second line of therapy or later (LOT2+) on or after September 1, 2015. The index date was the treatment initiation date for each LOT (multiple LOTs per patient were included) and the baseline was 6 months pre-index. MM-related and all-cause HCRU/costs were assessed during follow-up and reported per patient per month (PPPM; 2020 US Dollars). For MM-related costs only, treatment administration costs were excluded from outpatient (OP) costs and instead summed with pharmacy costs. HCRU/costs were compared between treatment groups using generalized linear models (GLMs). Cost variables were compared using 2-part models and GLM with log transformation and γ distribution. Inverse probability of treatment weighting (IPTW) adjusted for imbalance of baseline confounders across treatment groups. The study included 511 patients contributing 542 LOTs (IRd: n = 153; VRd: n = 262; KRd: n = 127). Before IPTW, mean observed time spent on therapy was 8.5, 9.3, and 7.3 months for the IRd, VRd, and KRd cohorts, respectively. During follow-up and after IPTW, IRd and VRd were associated with significantly fewer OP visits vs KRd. Post-IPTW comparisons of MM-related costs for IRd vs KRd yielded lower OP costs for IRd (mean diff. PPPM: -$3,428; < 0.001), contributing to lower total medical costs (-$3,813; < 0.001) and total health care cost savings with IRd vs KRd (-$5,813; = 0.001). MM-related OP costs were lower for VRd (mean diff. PPPM: -$3,543; < 0.001) than KRd, reducing its total MM-related medical costs (-$3,997; = 0.002), leading to total MM-related health care cost savings with VRd vs KRd (-$12,357; < 0.001). All-cause cost comparisons yielded similar results (total health care cost savings for IRd and VRd vs KRd: -$6,371 and -$13,629, respectively; all < 0.001). From the US insurance-payer perspective, patients treated with IRd and VRd had significant medical cost savings vs KRd due to lower OP costs when excluding treatment administration costs. The differential economic impacts of PI-Rd regimens in this study may help to inform treatment decisions for patients with MM. This study and article were supported by Takeda Development Center Americas, Inc. Dr Sanchez has no conflicts to declare. Dr Chari has the following relationships: Research Support/Principal Investigator: Amgen, Array Biopharma, Celgene, Glaxo Smith Klein, Janssen, Millenium/Takeda, Novartis Pharmaceuticals, Oncoceutics, Pharmacyclics, Seattle Genetics; Consultant: Amgen, Bristol-Myers Squibb, Celgene, Millenium/Takeda, Janssen, Karyopharm; Scientific Advisory Board: Amgen, Celgene, Millenium/Takeda, Janssen, Karyopharm, Sanofi, Seattle Genetics. Drs Cherepanov, Huang, Dabora, and Noga are current employees of Takeda, while Drs Stull and Young are ex-employees of Takeda; Drs Cherepanov and Huang also own stocks in Takeda. Dr DerSarkissian, Ms Cheng, Ms Zhang, Mr Banatwala, and Dr Duh are employees of Analysis Group, Inc. (AG), a consulting firm that received funding from Takeda to conduct this study. Ms Pi was an employee of AG at the time of the study. Dr Ailawadhi has the following relationships to declare: Research Support and Consulting for BMS, GSK, and Janssen; Research Support from AbbVie, Arch Oncology, Cellectar, Medimmune, Pharmacyclics, and Xencor; Consulting for Beigene, Oncopeptides, Regeneron, Sanofi, and Takeda.
目前可用的蛋白酶体抑制剂 (PI) 为基础的来那度胺-地塞米松 (Rd)-三联疗法中的经济差异-伊沙佐米 (I)、硼替佐米 (V) 和卡非佐米 (K) 加 Rd-仍知之甚少。 评估美国复发性/难治性多发性骨髓瘤 (RRMM) 患者接受 IRd、VRd 和 KRd 治疗的医疗资源利用 (HCRU) 和医疗保健成本。 这项回顾性纵向队列研究使用 IQVIA PharMetrics Plus 裁决的索赔美国数据 (2015 年 1 月 1 日至 2020 年 9 月 30 日)，包括所有可用数据的成年患者，他们在 2015 年 9 月 1 日或之后开始二线或更高 (LOT2+) 的 IRd、VRd 或 KRd 治疗。索引日期是每个 LOT 的治疗起始日期 (每位患者有多个 LOT)，基线是索引前 6 个月。在随访期间评估了与 MM 相关的和所有原因的 HCRU/成本，并按每位患者每月 (2020 年美元) 报告 (PPPM)。对于仅与 MM 相关的成本，将门诊 (OP) 成本中的治疗管理成本排除在外，并与药房成本相加。使用广义线性模型 (GLM) 比较治疗组之间的 HCRU/成本。使用 2 部分模型和具有对数变换和 γ 分布的 GLM 比较成本变量。使用逆概率治疗加权 (IPTW) 调整治疗组之间基线混杂因素的不平衡。 该研究包括 511 名患者，共贡献了 542 个 LOT (IRd：n = 153；VRd：n = 262；KRd：n = 127)。在 IPTW 之前，IRd、VRd 和 KRd 队列的平均治疗时间分别为 8.5、9.3 和 7.3 个月。在随访和 IPTW 之后，IRd 和 VRd 与 KRd 相比，OP 就诊次数明显减少。IRd 与 KRd 相比，MM 相关成本的事后 IPTW 比较显示，IRd 的 OP 成本较低 (平均差异 PPPM：-3428 美元；<0.001)，导致总医疗费用 (-3813 美元；<0.001) 和总医疗保健成本节省 (-5813 美元；=0.001)。与 KRd 相比，VRd 的 MM 相关 OP 成本较低 (平均差异 PPPM：-3543 美元；<0.001)，降低了其 MM 相关总医疗费用 (-3997 美元；=0.002)，导致 VRd 与 KRd 相比，MM 相关总医疗保健成本节省 (-12357 美元；<0.001)。全因成本比较得出类似结果(IRd 和 VRd 与 KRd 的总医疗保健成本节省：-6371 美元和-13629 美元，均<0.001)。 从美国保险支付者的角度来看，由于排除治疗管理成本，IRd 和 VRd 治疗的患者与 KRd 相比，OP 成本显著降低，节省了医疗费用。这项研究中 PI-Rd 方案的不同经济影响可能有助于为 MM 患者的治疗决策提供信息。 这项研究和文章得到了武田开发中心美洲公司的支持。Sanchez 博士没有利益冲突要申报。Chari 博士有以下关系：研究支持/主要研究者：Amgen、Array Biopharma、Celgene、Glaxo Smith Klein、Janssen、Millenium/Takeda、Novartis Pharmaceuticals、Oncoceutics、Pharmacyclics、西雅图遗传学；顾问：Amgen、百时美施贵宝、Celgene、Millenium/Takeda、Janssen、Karyopharm；科学顾问委员会：Amgen、Celgene、Millenium/Takeda、Janssen、Karyopharm、Sanofi、西雅图遗传学。Cherepanov 博士、Huang 博士、Dabora 博士和 Noga 博士是武田公司的现任员工，而 Stull 博士和 Young 博士是武田公司的前员工；Cherepanov 博士和 Huang 博士还拥有武田公司的股票。DerSarkissian 博士、程女士、张女士、Banatwala 先生和 Duh 博士是咨询公司 Analysis Group，Inc. (AG) 的员工，该公司受武田公司委托进行了这项研究。Pi 女士在研究期间是 AG 的员工。Ailawadhi 博士有以下关系需要申报：与 BMS、GSK 和 Janssen 的研究支持和咨询；与 AbbVie、Arch Oncology、Cellectar、Medimmune、Pharmacyclics 和 Xencor 的研究支持；与 Beigene、Oncopeptides、Regeneron、Sanofi 和 Takeda 的咨询。
