COST-EFFECTIVENESS OF POST-AUTOTRANSPLANT LENALIDOMIDE IN PERSONS WITH MULTIPLE MYELOMA.
Considerable data indicate posttransplant lenalidomide prolongs progression-free survival and probably survival after an autotransplant for plasma cell myeloma (PCM). However, optimal therapy duration is unknown, controversial and differs in the EU and US. We compared outcomes and cost-effectiven...
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doaj-7451f523b1314f83886c3be8348e3f442021-05-04T02:56:14ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062021-04-0113110.4084/MJHID.2021.034COST-EFFECTIVENESS OF POST-AUTOTRANSPLANT LENALIDOMIDE IN PERSONS WITH MULTIPLE MYELOMA.Monia Marchetti 0Robert Peter Gale1Giovanni BarosiOspedale di AlessandriaHaematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK. Considerable data indicate posttransplant lenalidomide prolongs progression-free survival and probably survival after an autotransplant for plasma cell myeloma (PCM). However, optimal therapy duration is unknown, controversial and differs in the EU and US. We compared outcomes and cost-effectiveness of 3 posttransplant lenalidomide strategies in EU and US settings: (1) none; (2) until failure; and (3) 2-year fixed duration. We used a Markov decision model which included 6 health states and informed by published data. The model estimated the strategy of lenalidomide given to failure achieved 1.06 quality-adjusted life years (QALYs) at costs per QALY gained of €29,232 in the EU and $133,401 in the US settings. Two-year fixed-duration lenalidomide averted €7,286 per QALY gained in the EU setting and saved 0.84 QALYs at $60,835 per QALY gained in the US setting. These extremely divergent costs per QALY in the EU and US settings resulted from large differences in costs of posttransplant lenalidomide and of 2nd-line therapies driven by whether posttransplant failure was on- or off-lenalidomide. In Monte Carlo simulation analyses which allowed us to account for variability of inputs, 2-year fixed-duration lenalidomide remained the preferred strategy for improving health-care sustainability in the EU and US settings. https://www.mjhid.org/index.php/mjhid/article/view/4555plasma cell myelomalenalidomideautotransplantcost-effectivenessdecision models |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Monia Marchetti Robert Peter Gale Giovanni Barosi |
spellingShingle |
Monia Marchetti Robert Peter Gale Giovanni Barosi COST-EFFECTIVENESS OF POST-AUTOTRANSPLANT LENALIDOMIDE IN PERSONS WITH MULTIPLE MYELOMA. Mediterranean Journal of Hematology and Infectious Diseases plasma cell myeloma lenalidomide autotransplant cost-effectiveness decision models |
author_facet |
Monia Marchetti Robert Peter Gale Giovanni Barosi |
author_sort |
Monia Marchetti |
title |
COST-EFFECTIVENESS OF POST-AUTOTRANSPLANT LENALIDOMIDE IN PERSONS WITH MULTIPLE MYELOMA. |
title_short |
COST-EFFECTIVENESS OF POST-AUTOTRANSPLANT LENALIDOMIDE IN PERSONS WITH MULTIPLE MYELOMA. |
title_full |
COST-EFFECTIVENESS OF POST-AUTOTRANSPLANT LENALIDOMIDE IN PERSONS WITH MULTIPLE MYELOMA. |
title_fullStr |
COST-EFFECTIVENESS OF POST-AUTOTRANSPLANT LENALIDOMIDE IN PERSONS WITH MULTIPLE MYELOMA. |
title_full_unstemmed |
COST-EFFECTIVENESS OF POST-AUTOTRANSPLANT LENALIDOMIDE IN PERSONS WITH MULTIPLE MYELOMA. |
title_sort |
cost-effectiveness of post-autotransplant lenalidomide in persons with multiple myeloma. |
publisher |
PAGEPress Publications |
series |
Mediterranean Journal of Hematology and Infectious Diseases |
issn |
2035-3006 |
publishDate |
2021-04-01 |
description |
Considerable data indicate posttransplant lenalidomide prolongs progression-free survival and probably survival after an autotransplant for plasma cell myeloma (PCM). However, optimal therapy duration is unknown, controversial and differs in the EU and US. We compared outcomes and cost-effectiveness of 3 posttransplant lenalidomide strategies in EU and US settings: (1) none; (2) until failure; and (3) 2-year fixed duration. We used a Markov decision model which included 6 health states and informed by published data. The model estimated the strategy of lenalidomide given to failure achieved 1.06 quality-adjusted life years (QALYs) at costs per QALY gained of €29,232 in the EU and $133,401 in the US settings. Two-year fixed-duration lenalidomide averted €7,286 per QALY gained in the EU setting and saved 0.84 QALYs at $60,835 per QALY gained in the US setting. These extremely divergent costs per QALY in the EU and US settings resulted from large differences in costs of posttransplant lenalidomide and of 2nd-line therapies driven by whether posttransplant failure was on- or off-lenalidomide. In Monte Carlo simulation analyses which allowed us to account for variability of inputs, 2-year fixed-duration lenalidomide remained the preferred strategy for improving health-care sustainability in the EU and US settings.
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topic |
plasma cell myeloma lenalidomide autotransplant cost-effectiveness decision models |
url |
https://www.mjhid.org/index.php/mjhid/article/view/4555 |
work_keys_str_mv |
AT moniamarchetti costeffectivenessofpostautotransplantlenalidomideinpersonswithmultiplemyeloma AT robertpetergale costeffectivenessofpostautotransplantlenalidomideinpersonswithmultiplemyeloma AT giovannibarosi costeffectivenessofpostautotransplantlenalidomideinpersonswithmultiplemyeloma |
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