Costs per Month Free of Progression or Death of Targeted Therapies in the Treatment of Relapsed/Refractory Multiple Myeloma
Authors: Yang Hongbo , Roy Anuja , Yang Chelsey , McDonald Evangeline , Krishna Arun , Kuriakose Emil T , Globe Denise , Siegel David , Jagannath Sundar 
Published: October 2019

Abstract
Background: Almost all patients with multiple myeloma will eventually become relapsed/refractory (RRMM). Current treatments for RRMM are mainly targeted therapies, composed of dual and triple agents including proteasome inhibitors (PIs) with dexamethasone and/or immunomodulatory drugs (IMiDs). Panobinostat, a treatment with a novel mechanism of action by inhibiting histone deacetylase, has been recently approved to be used in combination with bortezomib (a PI) and dexamethasone for the treatment of RRMM patients who have received least 2 prior regimens including bortezomib and an IMiD.
Objective: To estimate cost per treated patient and cost per month free of progression or death for different targeted therapies among RRMM patients with at least 2 prior regimens.
Methods: FVD, K, KRD, PD, RVD, RD and VD were evaluated. D, F, K, P, R, V referred to dexamethasone, panobinostat, carfilzomib, pomalidomide, lenalidomide, and bortezomib, respectively. The model had a 1-year time horizon. Progression-free survival (PFS) Kaplan-Meier curves of these treatments among RRMM patients with at least 2 prior regimens was obtained from the literature where direct evidence was available, otherwise, was estimated by adjusting the PFS of the respective treatments among RRMM patients with at least 1 prior regimen. The durations of PFS within 1 year were estimated using area under the curve method. The cost per treated patient, from a US payer perspective, was estimated, composed of drug costs, administration costs, monitoring and prophylaxis costs, costs for treating adverse events, and costs incurred following disease progression or death. The cost per month free of progression or death was estimated for each regimen, by using cost per treated patient divided by duration of PFS within 1 year.
Results: The duration of PFS (months), in descending order, within 1 year of treatment initiation were 10.2, 8.6, 7.8, 7.6, 6.4, 5.4, 5.1 for KRD, FVD, RVD, RD, VD, PD and K, respectively. The costs ($) per month free of progression or death for these regimens were 22,714, 15,860, 22,201, 16,380, 17,665, 25,417, and 21,158, respectively.
Conclusion: The results suggested that KRD and FVD were associated with longer PFS duration compared to other targeted therapy regimens; FVD and RD were associated with a lower cost per month free of progression or death. Cost per month free of progression or death presented a new metric which might be considered when evaluating treatment options.

Disclosures
Yang: Shire Pharmaceuticals Inc.: Other: Hongbo Yang is an employee of Analysis Group Inc, which has received consultancy fees from Shire Pharmaceuticals Inc.; Takeda Pharmaceuticals U.S.A., Inc.: Consultancy, Other: Hongbo Yang is an employee of Analysis Group Inc, which has received consultancy fees from Takeda Pharmaceuticals U.S.A., Inc.; Sanofi: Consultancy, Other: Hongbo Yang is an employee of Analysis Group Inc, which has received consultancy fees from Sanofi; Millennium Pharmaceuticals, Inc.: Consultancy, Other: Hongbo Yang is an employee of Analysis Group Inc, which has received consultancy fees from Millennium Pharmaceuticals, Inc.; Jazz Pharmaceuticals Inc.: Consultancy, Other: Hongbo Yang is an employee of Analysis Group Inc, which has received consultancy fees from Jazz Pharmaceuticals Inc.; Astellas Pharma US, Inc.: Consultancy, Other: Hongbo Yang is an employee of Analysis Group Inc, which has received consultancy fees from Astellas Pharma US, Inc.; Abbvie Inc.: Consultancy, Other: Hongbo Yang is an employee of Analysis Group Inc, which has received consultancy fees from Abbvie Inc.; Novartis Pharmaceuticals Corporation: Consultancy, Other: Hongbo Yang is an employee of Analysis Group Inc, which has received consultancy fees from Novartis Pharmaceuticals Corporation. Off Label Use: Management of Multiple Myeloma. Roy:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Yang:Sanofi: Consultancy, Other: Chelsey Yang is an employee of Analysis Group Inc, which has received consultancy fees from Sanofi; Forest Laboratories, Inc.: Consultancy, Other: Chelsey Yang is an employee of Analysis Group Inc, which has received consultancy fees from Forest Laboratories, Inc.; Novartis Pharmaceuticals Corporation: Consultancy, Other: Chelsey Yang is an employee of Analysis Group Inc, which has received consultancy fees from Novartis Pharmaceuticals Corporation; Bristol-Myers Squibb Company: Consultancy, Other: Chelsey Yang is an employee of Analysis Group Inc, which has received consultancy fees from Bristol-Myers Squibb Company; AbbVie Inc.: Consultancy, Other: Chelsey Yang is an employee of Analysis Group Inc, which has received consultancy fees from Abbvie Inc.; Astellas Pharma US, Inc.: Consultancy, Other: Chelsey Yang is an employee of Analysis Group Inc, which has received consultancy fees from Astellas Pharma US, Inc.; Shire Pharmaceuticals Inc.: Consultancy, Other: Chelsey Yang is an employee of Analysis Group Inc, which has received consultancy fees from Shire Pharmaceuticals Inc.; Millennium Pharmaceuticals, Inc.: Other: Chelsey Yang is an employee of Analysis Group Inc, which has received consultancy fees from Millennium Pharmaceuticals, Inc. ; GE Healthcare: Consultancy, Other: Chelsey Yang is an employee of Analysis Group Inc, which has received consultancy fees from GE Healthcare. McDonald:AbbVie Inc.: Consultancy, Other: Evangeline McDonald is an employee of Analysis Group Inc, which has received consultancy fees from AbbVie Inc.; Astellas Pharma US, Inc.: Consultancy, Other: Evangeline McDonald is an employee of Analysis Group Inc, which has received consultancy fees from Astellas Pharma US, Inc.; Bristol-Myers Squibb Company: Consultancy, Other: Evangeline McDonald is an employee of Analysis Group Inc, which has received consultancy fees from Bristol-Myers Squibb Company; Millennium Pharmaceuticals, Inc.: Consultancy, Other: Millennium Pharmaceuticals, Inc.; Pfizer Inc.: Consultancy, Other: Evangeline McDonald is an employee of Analysis Group Inc, which has received consultancy fees from Pfizer Inc.; Otsuka America Pharmaceutical, Inc.: Consultancy, Other: Evangeline McDonald is an employee of Analysis Group Inc, which has received consultancy fees from Otsuka America Pharmaceutical, Inc.; AstraZeneca: Other: Evangeline McDonald is an employee of Analysis Group Inc, which has received consultancy fees from AstraZeneca; Takeda Pharmaceuticals U.S.A., Inc.: Consultancy, Other: Evangeline McDonald is an employee of Analysis Group Inc, which has received consultancy fees from Takeda Pharmaceuticals U.S.A., Inc.; Shire Pharmaceuticals Inc.: Consultancy, Other: Evangeline McDonald is an employee of Analysis Group Inc, which has received consultancy fees from Shire Pharmaceuticals Inc.; Novartis Pharmaceuticals Corporation: Consultancy, Other: Evangeline McDonald is an employee of Analysis Group Inc, which has received consultancy fees from Novartis Pharmaceuticals Corporation. Krishna:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Kuriakose:Novartis: Employment, Equity Ownership. Globe:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Siegel:Celgene Corporation: Consultancy, Speakers Bureau; Amgen: Speakers Bureau; Takeda: Speakers Bureau; Novartis: Speakers Bureau; Merck: Speakers Bureau. Jagannath:Celgene: Honoraria; MERCK: Honoraria; Janssen: Honoraria; BMS: Honoraria; Novartis Pharmaceuticals Corporation: Honoraria.