Gordan Lucio N, Bensimon Arielle G, Mu Fan, Kim Nina, Wu Bingcao, Lin Dee, Paner Agne, Fowler Jessica, Marshall Alex, Van Sanden Suzy, Ammann Eric, Goble Joe, Zhang Xinke, Le Hoa H, Min Elissa E, Garrison Louis P
Florida Cancer Specialists & Research Institute, Gainesville, FL, USA.
Analysis Group, Inc, Boston, MA, USA.
J Med Econ. 2025 Dec;28(1):910-920. doi: 10.1080/13696998.2025.2514909. Epub 2025 Jun 14.
Teclistamab and elranatamab are bispecific antibodies recently approved for the treatment of triple class-exposed relapsed/refractory multiple myeloma (RRMM). This study assessed the relative efficacy and economic value of teclistamab and elranatamab through a matching-adjusted indirect comparison (MAIC) and cost per responder analysis using data from the MajesTEC-1 (NCT03145181/NCT04557098) and MagnetisMM-3 (NCT04649359) trials.
The MAIC compared overall response rate (ORR) between the therapies after weighting individual patient data from MajesTEC-1 to match key baseline characteristics in MagnetisMM-3. Matched covariates included age, refractory status, prior lines of therapy, extramedullary disease, performance status, disease stage, and cytogenetic risk profile. Cost per responder was calculated based on estimated per-patient drug acquisition and administration cost (2024 United States dollars) over 6 months divided by ORR. One-way and probabilistic sensitivity analyses were conducted to characterize uncertainty.
The ORRs were 63.0% for teclistamab before matching ( = 165), 61.4% for teclistamab after matching (effective sample size = 92), and 61.0% for elranatamab ( = 123) (odds ratio after matching: 1.02; 95% confidence interval [CI]: 0.59, 1.77). Per-patient costs were estimated to be $231,435 for teclistamab and $285,201 for elranatamab (difference: -$53,766; 95% confidence interval [CI]: -$59,094, -$48,311), yielding costs per responder of $376,930 and $467,730, respectively (difference: --$90,800; 95% CI: -$183,680, $8,148).
Because MajesTEC-1 and MagnetisMM-3 are single-arm trials, the MAIC was unanchored and therefore susceptible to confounding from any unadjusted effect modifiers or prognostic variables.
Teclistamab was associated with significantly lower treatment costs and numerically lower cost per responder than elranatamab in triple class-exposed RRMM.
替西妥单抗和埃拉纳妥单抗是最近被批准用于治疗经三类药物治疗的复发/难治性多发性骨髓瘤（RRMM）的双特异性抗体。本研究通过匹配调整间接比较（MAIC）以及使用来自MajesTEC-1（NCT03145181/NCT04557098）和MagnetisMM-3（NCT04649359）试验的数据进行每应答者成本分析，评估了替西妥单抗和埃拉纳妥单抗的相对疗效和经济价值。
MAIC在对MajesTEC-1的个体患者数据进行加权以匹配MagnetisMM-3的关键基线特征后，比较了各治疗组之间的总缓解率（ORR）。匹配的协变量包括年龄、难治状态、既往治疗线数、髓外疾病、体能状态、疾病分期和细胞遗传学风险概况。每应答者成本基于6个月内估计的每位患者药物采购和给药成本（2024美元）除以ORR来计算。进行了单向和概率敏感性分析以描述不确定性。
匹配前替西妥单抗的ORR为63.0%（n = 165），匹配后替西妥单抗的ORR为61.4%（有效样本量 = 92），埃拉纳妥单抗的ORR为61.0%（n = 123）（匹配后的优势比：1.02；95%置信区间[CI]：0.59，1.77）。替西妥单抗的每位患者成本估计为231,435美元，埃拉纳妥单抗为285,201美元（差值：-$53,766；95%置信区间[CI]：-$59,094，-$48,311），每应答者成本分别为376,930美元和467,730美元（差值：-$90,800；95% CI：-$183,680，$8,148）。
由于MajesTEC-1和MagnetisMM-3是单臂试验，MAIC没有固定锚点，因此容易受到任何未调整的效应修饰因素或预后变量的混杂影响。
在经三类药物治疗的RRMM中，替西妥单抗的治疗成本显著低于埃拉纳妥单抗，且每应答者成本在数值上也更低。
