PCN163 SEQUENTIAL TREATMENT REGIMENS FOR ELDERLY PATIENTS WITH MULTIPLE MYELOMA: A COST-EFFECTIVENESS ANALYSIS INCLUDING EXPERIENCE FROM REAL-WORLD DATA

Multiple myeloma (MM) is a neoplasm affecting mainly elderly people. Newly introduced, potent and expensive treatment strategies have substantially prolonged the survival of patients with MM. Treatment strategies include combination therapies, which are often sequentially applied after treatment failure. Our aimed to evaluate the long-term effectiveness and cost-effectiveness of different sequential treatment regimens for elderly patients with MM ineligible for stem cell transplantation (SCT). We developed a state-transition Markov model to project life expectancy (LE), lifetime costs, and incremental cost-effectiveness ratios (ICERs) of five sequential treatment options for elderly patients with MM in Austria. We compared the effectiveness and cost-effectiveness of two different scenarios: (1) treatment schedule derived from clinical trials; (2) treatment schedule according to experts’ suggestions with experience from the Austrian Myeloma Registry. Treatment strategies are named according to their first-line treatment: melphalan/prednisone/bortezomib (MPV); melphalan/prednisone/thalidomide (MPT); bortezomib/thalidomide/dexamethasone (VTd); bortezomib/dexamethasone (Vd); and lenalidomide/dexamethasone (Rd). Further-line treatments also included carfilzomib, pomalidomide, and cyclophosphamide. Effectiveness parameters were extracted from international clinical trials. We included only direct costs and applied a discount rate of 3% for both, health outcomes and costs. Several deterministic sensitivity analyses were performed. ‘Starting with MPV’ resulted in the highest LE ((1) 5.64 life-years, (2) 5.63 life-years), ‘Starting with MPT’ in the lowest LE ((1) 4.57 life-years; (2) with thalidomide-maintenance: 4.71 life-years). ‘Starting with MPV’ yielded an ICER of 113,000 EUR/life-years gained relative to ‘Starting with VTd’ in scenario (1). The remaining strategies were dominated. In scenario (2), ‘Starting with MPV’ resulted in an ICER of 56,000 EUR/life-years gained compared to ‘Starting with Vd’. Sensitivity analyses showed the robustness of the results. The treatment strategy ‘Starting with MPV’ is likely to be a cost-effective treatment option for elderly patients with MM in Austria. Future analyses should incorporate the impact on patient quality of life.