Budget impact analysis of the use of oral and intravenous therapy regimens for the treatment of relapsed or refractory m
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ORIGINAL PAPER
Budget impact analysis of the use of oral and intravenous therapy regimens for the treatment of relapsed or refractory multiple myeloma in Germany Edin Basic1 · Mathias Kappel2 · Arpit Misra2 · Leopold Sellner1 · Boris A. Ratsch1 · Dennis A. Ostwald2,3 Received: 1 November 2019 / Accepted: 3 July 2020 © The Author(s) 2020
Abstract Background In Germany, several triplet therapies for treating relapsed or refractory multiple myeloma (rrMM) patients have recently been approved. While most of them are administered intravenously, ixazomib-based combination is the only orally bioavailable regimen. Objective To conduct a 1-year and 3-year budget impact analysis (BIA) of different novel triplets to treat patients with rrMM in second or subsequent therapy lines accounting for costs covered by German statutory health insurance (SHI). Methods A 3-state partitioned survival model (PSM) was developed to evaluate the budget impact of the following regimens: carfilzomib plus lenalidomide plus dexamethasone (KRd), elotuzumab plus lenalidomide plus dexamethasone (ERd), daratumumab plus lenalidomide plus dexamethasone (DRd), and ixazomib plus lenalidomide plus dexamethasone (IRd). The analysis included direct medical costs such as drug acquisition, comedication and preparation for parenteral solutions, drug administration and other 1-time costs, adverse event management costs and direct non-medical costs, such as transportation costs. Results Based on current drug market shares in German healthcare market, the estimated costs after 1 year of treatment was €551 million (KRd), €163 million (ERd), €584 million (DRd), and €95 million (IRd). The total budget impact of €1393 million is mainly driven by drug acquisition and subsequent therapy costs. Conclusion Among the regimens of interest, the oral-based therapy regimens offered cost advantages over intravenousbased therapy regimens. The higher overall costs of intravenous therapy regimens were attributed primarily to higher drug acquisition costs. Keywords Budget impact analysis · Relapsed/refractory multiple myeloma · Progression-free survival · Partitioned survival analysis · Intravenous therapies · Oral therapies JEL Classification I11
Introduction Multiple myeloma (MM) is an incurable, heterogeneous blood cancer with serious disease-related complications accounting for 1% of all cancer diagnoses worldwide and * Edin Basic [email protected] 1
Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
2
Health Economics, WifOR, Darmstadt, Germany
3
School of International Business and Entrepreneurship (SIBE), Steinbeis University Berlin, Berlin, Germany
13% of all hematologic malignancies [1]. In Germany, there are around 6500 new cases of MM each year with the median age at onset of 71 years for men and 74 years for women [2]. During the course of the disease, nearly all patients with MM relapse or become refractory to the upfront therapy. More recently, several new agents, such as the proteasome inhibitors (PIs) carfilzomib and ixazomib, and t
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