Cost-per-responder analysis of daratumumab, bortezomib, lenalidomide, and dexamethasone vs bortezomib, lenalidomide, and dexamethasone among transplant-eligible patients with newly diagnosed multiple myeloma.

Abstract

Background: The phase 3 PERSEUS trial demonstrated superior efficacy of daratumumab (D), bortezomib (V), lenalidomide (R), and dexamethasone (d) induction/consolidation followed by DR maintenance (DVRd/DR) vs VRd induction/consolidation followed by R maintenance (VRd/R) in transplant-eligible patients with newly diagnosed multiple myeloma.

Objective: To assess the economic value associated with achieving and sustaining minimal residual disease (MRD)-negative status with DVRd/DR vs VRd/R.

Methods: A model of cost per patient with MRD-negative status was developed from a US mixed-payer perspective (60% Medicare, 40% commercial) using PERSEUS trial data. Model inputs included costs for first-line (1L) and second-line (2L) treatment, autologous stem cell transplant, medical care, adverse event management, and MRD testing. Outcomes included the cost per MRD-negative patient, calculated using the cost per treated patient and cumulative proportion of patients achieving MRD-negative status at 48 months after randomization, and cost per patient sustaining MRD negativity for at least 12 months during maintenance, calculated using maintenance treatment costs and the proportion of patients who converted from MRD-positive at the end of consolidation to achieving sustained MRD-negative status during maintenance. Costs were reported in 2025 US dollars.

Results: At 48 months, the total cost per patient with MRD-negative status was lower with DVRd/DR compared with VRd/R ($519,999 less). Key drivers of these cost savings included the lower maintenance treatment costs per MRD-negative patient ($106,707 less) and the lower 2L treatment costs per MRD-negative patient ($434,184 less) with DVRd/DR compared with VRd/R. The lower maintenance treatment costs with DVRd/DR were attributable to the higher proportion of patients achieving MRD-negative status. The lower 2L treatment costs with DVRd/DR were attributable to the lower proportion of patients initiating 2L (9.4%) compared with VRd/R (26.8%). Among patients who were MRD-positive at the end of consolidation, the cost per patient achieving sustained MRD-negative status was lower with DVRd/DR vs VRd/R, resulting in savings of $961,880. This was primarily attributable to a higher proportion of patients achieving sustained MRD-negative status with DVRd/DR (44.2%) than with VRd/R (22.6%) during the maintenance phase.

Conclusions: The cost per MRD-negative patient and the cost per patient achieving sustained MRD negativity during maintenance were lower with DVRd/DR compared with VRd/R. These findings demonstrate the cost savings associated with the use of DVRd induction/consolidation followed by DR maintenance for transplant-eligible patients with newly diagnosed multiple myeloma, supplementing the superior efficacy benefits relative to VRd induction/consolidation demonstrated in the PERSEUS trial.