Pharmacoeconomic Analysis of Ixazomib Combined with Lenalidomide and Dexamethasone in Adult Patients with Relapsed or Refractory Multiple Myeloma
Aims. 1. To assess the economic effectiveness of the use of ixazomib combined with lenalidomide and dexamethasone in patients with multiple myeloma (MM), who received at least one line of prior therapy. 2. To analyze the impact of the introduction of ixazomib into the Program of State Guarantees for Free Medical Care on the budget of health care system of the Russian Federation. Methods. The cost-utility analysis of the use of ixazomib with lenalidomide and dexamethasone from the point of Russian health care was performed using a global model created for the United Kingdom and filled with Russian data. The difference between direct medical costs and the incremental cost- effectiveness for a quality-adjusted life-year was calculated for each of the triple treatment schedules (ixazomib + lenalidomide + dexamethasone, and carfilzomib + lenalidomide + dexamethasone) compared with lenalidomide + dexamethasone schedule.The model created in Microsoft Excel assessed the impact of the introduction of ixazomib on the Russian health care budget. The data from government statistics; expert survey of hematologists; registered prices of drugs included on the List of Vital and Essential Drugs (LVED); estimated price of ixazomib provided by the manufacturer for the application for the inclusion into LVED; the prices of state procurement of drugs; and standard financial costs of medical care in Russia in 2017 were used. Results. The cost of a quality-adjusted life year in patients with MM, who received at least one line of prior treatment, was lower in case of a triple schedule with ixazomib than in case of the schedule with carfilzomib, compared with the combination of lenalidomide and dexamethasone (7.01 and 7.92 million RUB; and 2.07 and 9,08 million RUB in the population with a high risk of chromosome aberrations, respectively).The results of the budget impact analysis showed that the introduction of ixazomib into the clinical practice would save 992.09 million RUB (4.18%)in the first three years. The sensitivity analysis showed that the results of modelling were robust to the changes of the input parameters. Conclusion. The cost of a quality-adjusted life year is lower for the schedule with ixazomib than for the schedule with carfilzomib compared to lenalidomide and dexamethasone combination. This suggests that the inclusion of ixazomib into the LVED will be a cost-effective solution. The introduction of ixazomib into the clinical practice will reduce the burden of additional costs connected with the use of novel drugs for the treatment of MM.