Cesar Augusto Guevara-Cuellar1* and Elizabeth Parody Rua2
1Department of Health Sciences, ICESI University, Colombia
2Department of Natural Sciences, ICESI University, Colombia
Objective: To conduct a cost-effectiveness assessment of bortezomib plus cyclophosphamide plus dexamethasone (CyBorD) versus bortezomib plus thalidomide plus dexamethasone (VTD) versus lenalidomide plus dexamethasone (RD) as initial treatment for transplant-eligible patients with newly-diagnosed multiple myeloma (MM), from a Colombian payer perspective.
Methods: A Markov model was developed to estimate quality-adjusted life years (QALYs), direct costs and incremental costs per QALY gained associated with use of three chemotherapy regimens over a patient's lifetime. Information on the efficacy, security and costs of the regimens was based on data from phase III clinical trials and national tariff respectively. Direct costs included the costs of CyBorD, VTD and RD, treatment of adverse events, prophylaxis and monitoring associated with MM. Post-progression direct costs included costs of bortezomib plus lenalidomide plus dexamethasone and monitoring for progressive disease. Utilities were obtained from the published studies and Tufts registry. Costs and outcomes were discounted at 0%, 3.5%, 5%, 7% and 12% annually. A probabilistic sensitivity analysis (PSA) using Monte Carlo simulation was performed.
Results: The undiscounted costs of CyBorD, RD and VTD were USD $48.892; $50.863 and $52.835 respectively. QALY´s for these alternatives were 5.53, 3.48 and 4.03 respectively (undiscounted). RD and VTD were dominated by CyBorD. This finding was robust in the PSA for each iteration.
Conclusion: CyBorD dominated to VTD and RD as induction therapy of chemotherapy in transplant-eligible patients with active MM and standard risk from the Colombian payer perspective.
Cyclophosphamide; Bortezomib; Dexamethasone; Thalidomide
Guevara-Cuellar CA, Rua EP Cost-Effectiveness of Bortezomib Plus Cyclophosphamide Plus Dexamethasone Versus Bortezomib Plus Thalidomide Plus Dexamethasone Versus Lenalidomide Plus Dexamethasone as Induction Therapy for Transplant-Eligible Patients with Newly-Diagnosed Multiple Myeloma in Colombia. J Hematol Mult Myeloma. 2016;1(1):1001.