COST-EFFECTIVENESS ANALYSIS OF SUBCUTANEOUS DARATUMUMAB VERSUS INTRAVENOUS DARATUMUMAB IN NEWLY DIAGNOSED MULTIPLE MYELOMA

Abstract

Background: Both subcutaneous (SC) and intravenous (IV) formulations of Daratumumab (Dara) are used, in combination with lenalidomide, bortezomib, and dexamethasone (VRd), for treating newly diagnosed multiple myeloma (NDMM) patients at Hamad Medical Cooperation (HMC). However, the choice between formulations is based on physician preference and patient factors rather than evidence-based guidelines. Chemotherapies are relatively expensive, particularly in relation to hospitalization and side effects. Therefore, it is crucial to conduct local investigations to determine the trade-off between the costs of Dara formulations and their benefits. Understanding the resource usage differences between the formulations is essential for assessing their impact on hospital budgets and guiding decision-making. In the international literature, there are no cost-effectiveness analyses that compare SC and IV Dara in combination with VRd. objective: The aim of this thesis is to develop a thorough simulation-based economic decision-analytic model to assess the cost-effectiveness of SC Dara in combination with VRd, compared to Dara IV combined with VRd, for the treatment of NDMM patients eligible for transplant. This cost-effectiveness analysis will be conducted from the perspective of HMC in Qatar. Methods: One decision-analytic simulation model was developed to evaluate the use of two Dara formulations (SC versus IV) and their possible consequences in patients with NDMM eligible for transplant. Outcome measures were incremental cost- effectiveness ratio (ICER), cost difference, and success difference. Therapy success was defined as patients who underwent transplantation and did not relapse for 2 years afterward with or without adverse events. One-way sensitivity and multivariate analysis were conducted via a Monte Carlo simulation. Results: with an ICER of one million QAR with Dara IV per case of success and relative to a willingness to pay threshold of QAR 547,500 in Qatar, Dara SC was the cost-effective therapy option. Despite Dara IV being dominant over Dara SC in 41.64% of the simulated cases (higher effect and lower cost), Dara SC maintained cost-effective in 54,72% of the simulated cases. For the cost difference, in 87.3% of the simulated cases Dara IV was cheaper than Dara SC. For success, Dara IV was less efficacious than Dara SC in 47.5% of the simulated cases. Conclusion: for the treatment of NDMM patients who are eligible for transplant, Dara SC seems to be cost-effective relative to Dara IV.