Health care costs among patients with relapsed/refractory multiple myeloma treated with ixazomib or daratumumab in combination with lenalidomide and dexamethasone in the United States.

Abstract

Background: Available treatments for relapsed/refractory multiple myeloma (RRMM) include multiclass triplet regimens such as lenalidomide and dexamethasone (Rd backbone) plus ixazomib (proteasome inhibitor [PI]; I) or daratumumab (monoclonal antibody; D). Although prior real-world studies compared PI-Rd triplets, this research extends those findings by comparing health care costs of a PI-based and a monoclonal antibody-based triplet, IRd and DRd, in patients with RRMM in the United States.

Objective: To describe and compare all-cause and MM-related health care costs in patients with RRMM treated with IRd vs DRd.

Methods: This retrospective longitudinal study used fully adjudicated US claims data from IQVIA PharMetrics Plus (January 1, 2015, to September 30, 2020) and included adult patients who initiated IRd or DRd as second line of therapy (LOT) or later. Index date was the treatment initiation date for each LOT; baseline was 6 months pre-index. MM-related and all-cause costs per patient per month were assessed during follow-up (2020 US dollars). For MM-related costs, treatment administration costs were excluded from outpatient (OP) costs and instead summed with pharmacy costs. Costs were compared using 2-part models and generalized linear models. Inverse probability of treatment weighting was used to adjust for imbalances in baseline confounders across treatment groups.

Results: A total of 265 patients who initiated IRd or DRd were included in this analysis, contributing to 276 distinct LOTs (IRd: n = 153; DRd: n = 123). Baseline characteristics were similar between IRd and DRd cohorts after applying inverse probability of treatment weighting. Weighted (ie, adjusted) mean monthly MM-related total costs were significantly lower for the IRd cohort compared with the DRd cohort (-$8,141; P < 0.001). Total MM-related medical (-$4,764; P < 0.001), OP (-$3,152; P < 0.001), and pharmacy and OP treatment administration costs (-$3,563; P = 0.017) were also significantly lower for the IRd cohort.

Conclusions: When comparing patients with MM in the IQVIA PharMetrics Plus commercial insurance database, which reflects the payer perspective, significant cost savings were observed for patients treated with IRd vs DRd owing to lower OP and pharmacy costs. These findings may help inform real-world treatment and reimbursement decisions for patients with RRMM.