For patients with newly diagnosed multiple myeloma (NDMM) who are transplant candidates, triplet regimens like thalidomide, bortezomib, and dexamethasone (VTd) or lenalidomide, bortezomib, and dexamethasone (RVd) are the usual induction therapy. The rate of minimum residual disease (MRD) negative has increased as a result of the addition of daratumumab to RVd and VTd in the GRIFFIN and CASSIOPEIA trials, respectively.
For patients with NDMM who are transplant candidates, researchers compared the first-line and second-line usage of daratumumab in the trial using a cost-effectiveness analysis with a 10-year time horizon. In addition, they created a Markov model that uses MRD status to forecast progression-free survival because long-term follow-up data for these therapeutic trials are not currently available. Depending on the situation, daratumumab was either administered in the first-line setting with RVD or VTD or in the second-line setting with carfilzomib plus dexamethasone (Kd).
The incremental cost-effectiveness ratios and quality-adjusted life-years (QALYs) were estimated from the payer perspectives of Japan and the US. Compared to RVd, D-RVd had higher QALYs (5.43 vs. 5.18) and lower costs (¥64 479,793 vs. ¥71 287 569), whereas D-VTd had higher QALYs (5.67 vs. 5.42) and cheaper costs (¥43 600 310 vs. ¥49 471,941) than VTd. Similar to it, US research showed that daratumumab in first-line therapy regimens was a winning strategy.
The economic analysis showed that adding daratumumab to first-line RVd and VTd regimens was a dominating approach compared to saving its usage for the second-line scenario since total costs are lower and outcomes are better when daratumumab is administered as a part of a first-line regimen.