A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria, Belgium, Greece, and Italy

Abstract

Aim: The approved indication for denosumab (120 mg) was expanded in 2018 to include skeletalrelated event (SRE) prevention in patients with multiple myeloma (MM). Therefore, a cost-effectiveness analysis was conducted comparing denosumab with zoledronic acid (ZA) for SRE prevention in patients with MM from the national healthcare system perspective in a representative sample of European countries: Austria, Belgium, Greece, and Italy. Methods: The XGEVA global economic model for patients with MM was used to calculate incremental cost-effectiveness ratios (ICERs) for denosumab vs ZA over a lifetime horizon. Clinical inputs were derived from the denosumab vs ZA randomized, phase 3 study ("20090482") in patients newly-diagnosed with MM, and comprised real-world adjusted SRE rates, serious adverse event (SAE) rates, treatment duration, dose intensity, progression-free survival (PFS), and overall survival (OS). Economic inputs comprised country-specific denosumab and ZA acquisition and administration costs, SRE and SAE management costs, and discount rates. Health utility decrements associated with MM disease progression, SRE and SAE occurrence, and route of administration were included. Results: Estimated ICERs (cost per quality-adjusted life-year [QALY] gained) for denosumab vs ZA in Austria, Belgium, Greece, and Italy were e26,294, e17,737, e6,982, and e27,228, respectively. Using 1-3 times gross domestic product (GDP) per capita per QALY as willingness to pay thresholds, denosumab was 69-94%, 84-96%, 79-96%, and 50-92% likely to be cost-effective vs ZA, respectively. Limitations: Economic inputs were derived from various sources, and time to event inputs were extrapolated from 20090482 study data. Conclusions: Denosumab is cost-effective vs ZA for SRE prevention in patients with MM in Austria, Belgium, Greece, and Italy, based on often-adopted World Health Organization thresholds. This conclusion is robust to changes in model parameters and assumptions. Cost-effectiveness estimates varied across the four countries, reflecting differences in healthcare costs and national economic evaluation guidelines.

Management of bone health in solid tumours: From bisphosphonates to a monoclonal antibody

“…Treatments that reduce the incidence of SREs, therefore, have the potential to reduce the cost burden to healthcare services and society. While the acquisition cost of the monoclonal antibody denosumab is higher than that of generic bisphosphonates, cost-effectiveness analysis has shown that incremental costs per quality-adjusted life year (QALY) and per SRE avoided with denosumab are well below willingness-to-pay thresholds, and thus denosumab can be considered cost effective for prevention of SREs [111,112]. In an alternative costeffectiveness analysis conducted based on US data, denosumab and ZA were associated with similar QALYs gained, and thus the authors concluded that the lower cost of ZA made it the optimal treatment [113].…”

Controversies in the use of new bone‐modifying therapies in multiple myeloma

“…infusion of bisphosphonates during the coronavirus disease 2019 (COVID‐19) pandemic in order to reduce hospital visits or the length of hospital stay 66 . Economic models have also shown that denosumab is a cost‐effective treatment both in Europe 67 and the USA 68 …”

A Contingent Valuation Study for Eliciting a Monetary Value of a Quality-Adjusted Life-Year in the General Greek Population

“…times the country's gross domestic product (GDP) per capita to assess interventions' cost-effectiveness. [27][28][29] Nevertheless, no research has shed light on whether this threshold is appropriate for decision making or not. Moreover, related Greek studies that measure WTP per QALY (WTP/QALY) estimates have focused on discrete interventions/drugs for specific diseases, [28][29][30][31] and therefore WTP/QALY values refer to specific patient populations.…”

“…[27][28][29] Nevertheless, no research has shed light on whether this threshold is appropriate for decision making or not. Moreover, related Greek studies that measure WTP per QALY (WTP/QALY) estimates have focused on discrete interventions/drugs for specific diseases, [28][29][30][31] and therefore WTP/QALY values refer to specific patient populations. A previous Greek study 18 estimated a WTP/QALY value for an outpatient population, but study findings cannot be generalized to the Greek population.…”