The cost‐effectiveness of bortezomib in relapsed/refractory multiple myeloma: Swedish perspective

J Hornberger, J Rickert, R Dhawan… - European journal of …, 2010 - Wiley Online Library
J Hornberger, J Rickert, R Dhawan, J Liwing, J Aschan, M Löthgren
European journal of haematology, 2010Wiley Online Library
Objectives: To estimate the cost‐effectiveness of bortezomib (BTZ) compared with
dexamethasone (DEX) and lenalidomide plus dexamethasone (LEN/DEX) for the treatment
of relapsed/refractory multiple myeloma in Sweden. Methods: We used partitioned survival
analysis to assess survival data decomposed into three states:(i) alive before disease
progression;(ii) alive after progression; and (iii) dead. The effects of treatment on time to
progression and overall survival (OS) were obtained from published reports of the APEX …
Abstract
Objectives:  To estimate the cost‐effectiveness of bortezomib (BTZ) compared with dexamethasone (DEX) and lenalidomide plus dexamethasone (LEN/DEX) for the treatment of relapsed/refractory multiple myeloma in Sweden.
Methods:  We used partitioned survival analysis to assess survival data decomposed into three states: (i) alive before disease progression; (ii) alive after progression; and (iii) dead. The effects of treatment on time to progression and overall survival (OS) were obtained from published reports of the APEX, MM‐009, and MM‐010 randomized clinical trials. Costs included drug and administration costs, adverse events, treatment of relapses, and end‐of‐life costs. Utility estimates were derived from the literature.
Results:  BTZ mean OS was 57.4 months compared with 44.6 and 54.1 months for DEX and LEN/DEX, respectively. Mean lifetime direct medical costs per patient were approximately 2010 SEK 1 904 462, 1 278 854, and 2 450 588 for BTZ, DEX, and LEN/DEX, respectively. Mean incremental cost per quality‐adjusted life‐year of BTZ compared to DEX was 2010 SEK 902,874 (€95 073) (95% CI: 514 791, 962 416) and was dominant with respect to LEN/DEX.
Conclusion:  BTZ and LEN/DEX are projected to prolong survival relative to DEX. From a Swedish perspective, BTZ is cost‐effective compared to DEX and LEN/DEX.
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