Efficacy based on an indirect comparison (certolizumab pegol, golimumab excluded), fixed treatment sequence after the exhaustion of first bDMARD, Swedish resource use data according to HAQ scores, and inpatient costs assumed to include surgery.

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Multiple myeloma (MM) is one of the most prevalent hematologic cancers. Treatments of MM have been improved by availability of novel therapies but require regular hospital visits and intense patient follow-up. In this real-world study, patient characteristics, first four treatment lines (1L-4L), and associated outcomes and costs were assessed among adults treated for active MM during 2009-2016 at Kymenlaakso Central Hospital, Kymsote hospital district, Finland. In addition, patient burden and travel costs were determined for the patients treated during 2015-2016. Ninety-seven patients fulfilled the inclusion criteria. Data were retrospectively collected from hospital's database, medical charts, and from healthcare professionals. Treatment lines and responses were defined according to the general recommendations. The median age at diagnosis was 70.1 years. The median overall survival was 68 months. Proteasome inhibitors (PI) or immunomodulatory drugs (IM) were the most common regimen types while the utilisation of a more novel approach, the simultaneous use of PI and IM, was low across first four treatment lines. Overall response rate was 72-74% for 1L-2L and 50-56% for 3L-4L. Drug costs represented the greatest proportion of total healthcare costs and increased in the later treatment lines. Patients receiving infusion treatments had specialised health care visits twice as much the patients treated with oral treatments. Furthermore, travel costs related to infusion treatments were three to four times more compared to the respective costs for oral treatments. Increasing drug costs but poorer treatment outcomes in later treatment lines underline a need for more efficient and better tolerated treatment options. This study demonstrates that oral treatments may indeed reduce patient and hospital resource burden and thus, should be considered in future health economic evaluations in Finland.

for therapeutic regimen derived from GALLIUM and PRIMA clinical trials: in particular, progression-free survival (PFS), early progressive disease (PD), and treatment duration (TTOT) were extrapolated by fitting parametric distributions on empirical data in GALLIUM, whilst late PD on data in PRIMA, due to immature data in GALLIUM. PD state was split in early (progression within 2-years) and late since patients progressing early have much poorer survival outcomes than those progressing later. Expected survival was weighted by published utilities. Unit costs were collected from official and published Italian sources. Costs, updated to 2018 Euro, and health gains occurring after the first year were discounted at an annual 3% rate. Sensitivity and scenario analyses were carried out, with the aim of evaluating uncertainty around model assumptions. Results: Obinutuzumab is associated with incremental survival (1.3 LYs), even when weighted for quality (1.1 QALYs), and incremental costs (V 24,000), driven by longer treatment duration in the progression-free state relative to rituximab. Incremental ratios (around V 18,000 per LY and V 21,500 per QALY gained) are widely within the range considered acceptable by the Italian NHS. 1,000 PSA simulations confirm robustness of results to sensible variations in assumptions. Conclusions: Obinutuzumab has a superior clinical efficacy, as compared to rituximab, and should be considered a cost-effective option in the first line treatment of advanced FL in Italy: incremental cost-effectiveness ratios are below the threshold considered sustainable by developed countries.

No abstract