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Bortezomib, VELCADE ®, multiple myeloma, lenalidomide, REVLIMID ®, cost impact analysis
Multiple myeloma (MM) is a cancer caused by malignant plasma cells that accumulate mostly in the bone marrow. In Canada, the most common maintenance therapy options after autologous stem cell transplant (ASCT) are bortezomib and lenalidomide .
To determine the incremental cost between bortezomib and lenalidomide maintenance therapies for patients with MM post ASCT .
Analyses were conducted to compare the annual costs of bortezomib and lenalidomide maintenance treatments for patients with MM post ASCT in Canada. The base case analysis included the acquisition costs of the drugs and administration costs . Additional analyses were conducted which considered the cost of adverse events (AEs) and the cost of treating se cond primary malignancies (SPMs) .
In the Canadian healthcare system, the total annual per patient cost was $33,967 for bortezomib maintenance therapy versus $131,765 for lenalidomide maintenance therapy . One -way sensitivity analyses demonstrated that both A Es and SPMs had little impact on the incremental cost, and that differences between the two maintenance therapies were mainly due to the acquisition costs of the drugs.
Bortezomib is significantly less costly than lenalidomide, and is an econo mically reasonable maintenance treatment option for patients with MM post ASCT.
2. Mols F, Oerlemans S, Vos AH, et al. Health - related quality of life and disease- specific complaints among multiple myeloma patients up to 10 yr after diagnosis: results from a population -based study using the PROFIL ES registry. European J ournal of H aematology 2012; 89(4):311- 9.
3. Saini N, Mahindra A . Therapeutic strategies for the treatment of multiple myeloma. Discovery Medicine 2013; 15(83):251- 8.
4. Canadian Cancer Society (Web Page) Multiple Myeloma. Updated 2015. Avail able online at www.cancer.ca . Accessed: December 2015
5. National Comprehensive Cancer Network (Web Page) NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma Updated Available online at www.NCCN.org . Accessed: April 2014
6. Attal M, Lauwers -Cances V, Marit G, et al. Lenalidomide maintenance after stem -cell transplantation for multiple myeloma. The New England Journal of M edicine 2012; 366(19):1782- 91.
7. McCarthy PL, Owzar K, Hofmeister CC, et al. Lenalidomide after stem -cell transplantation for multiple myeloma. The New England J ournal of Medicine 2012; 366(19):1770- 81.
8. Sonneveld P, Schmidt -Wolf IG, van der Holt B, et al. Bortezomib induction and maintenance treatment in patients with newly diagnosed multiple myeloma: results of the randomized phase III HOVON- 65/ GMMG -HD4 trial. Journal of C linical Oncology: Official Journal of the American Society of Clinical Oncology 2012; 30(24):2946- 55.
9. Alberta Health Services (Web Page) Multiple Myeloma Clinical Practice Guideline Updated February 2015 Available online at http://www.albertahealthservices.ca/info/cancerg uidelines.aspx . Accessed: December 2015
10. Palumbo A, Cavallo F, Gay F, et al. Autologous transplantation and maintenance therapy in multiple myeloma. The New England J ournal of Medicine 2014; 371(10):895- 905.
11. Moreau P, Pylypenko H, Grosicki S, et al. Subcutaneous versus intravenous administration of bortezom ib in patients with relapsed multiple myeloma: a randomised, phase 3, non -inferiority study. The Lancet Oncology 2011; 12(5):431- 40.
12. Pan -Canadian Oncology Drug Review (Web Page) pCODR Expert Review Committee Final Recommendation, Bortezomib Updated Availab le online at www.pcodr.ca . Accessed: April 2014
13. Pan -Canadian Oncology Drug Review (Web Page) pCODR Expert Review Committee Final Recommendation, Lenalidomide Updated Available online at www.pcodr.ca . Accessed: April 2014
14. Tam VC, Ko YJ, Mittmann N, et al. Cost - effectiveness of systemic therapies for metastatic pancreatic cancer. Current O ncology 2013; 20(2):e90 -e106.
15. Cancer Care Ontario (Web Page) Drug Formulary, BORT Regimen, 2013 Upda ted Available online at www.cancercare.on.ca . Accessed: January 2014.
16. Government of Ontario (Web Page) Ontario Case Costing Initiative Updated Available online at www.occp.com . Accessed: April 2014
17. Ministry of Health and Long -term Care (Web Page) Ontario Health Insurance Schedule of Benefits and Fees Updated Available online at www.health.gov.on.ca . Accessed: April 2014
18. Ministry of H ealth and Long term Care (Web Page) Ontario Drug Benefit Formulary/Comparative Drug Index. Updated September 25 2014. Available online at https://www.healthinfo.moh.gov.on.ca/formular y/ . Acces sed: 2014.
19. Sonneveld P, Scheid C, van der Holt B, et al. Bortezomib Induction and Maintenance Treatment Improves Survival In Patients With Newly Diagnosed Multiple Myeloma:Extended Follow -Up Of The HOVON- 65/GMMG -HD4 Trial (#404) American Society of Hematol ogy. New Orleans, Louisiana, USA. December 9, 2013: 393- 394 (Ernest N. Morial Convention Center)
20. Fleurence RL, Hollenbeak CS . Rates and probabilities in economic modelling: transformation, translation and appropriate application. PharmacoEconomics 2007; 25(1):3 - 6.
21. Canadian Cancer Society Cancer Drug Access for Canadians (September 2009). Accessed October 2014, Available online at: http://www.colorectal - cancer.ca/IMG/pdf/ cancer_drug_access_report_ en.pdf .
22. Neben K, Lokhorst HM, Jauch A, et al. Administration of bortezomib before and after autologous stem cell transplantation improves outcome in multiple myeloma patients with deletion 17p. Blood 2012; 119(4):940- 8.