First-line autologous stem cell transplant (ASCT) is cost-effective in patients with newly diagnosed multiple myeloma (MM) but more research is needed to assess cost-effectiveness of other, newer antimyeloma regimens in different treatment-line settings, according to a systematic review of studies from 11 countries published over the past quarter of a century. The analysis was published in the journal PharmacoEconomics.

“For transplant-eligible MM patients, transplant is a cost-effective first-line treatment,” reported senior study author Professor David R. Lairson, PhD, co-director of the Center for Health Services Research at the University of Texas Houston Health Science Center School of Public Health in Houston, and coauthors.

However, the evidence for the relative cost effectiveness of other treatment regimens remains unclear and more research is needed, the researchers noted. Second-line bortezomib-based regimens, lenalidomide plus dexamethasone, and pomalidomide plus dexamethasone were each cost-effective compared with dexamethasone alone but which of these combinatorial regimens is the most cost-effective remains unclear.

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MM incidence rates have climbed in recent years, as baby boomers aged into late adulthood. MM treatment strategies have been changing rapidly over recent years, as well, thanks to newly approved agents and treatment regimens. Newer regimens are promising and benefit some patients; however, none are considered curative.

Previous systematic reviews have compared specific therapies. However, few comprehensive cost-effectiveness analyses have been undertaken that compare available therapies across treatment lines.

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To compare the cost effectiveness of treatment regimes, the authors searched research literature databases and identified 24 such assessments, published between 1990 and 2018, summarizing incremental cost-effectiveness ratio (ICER), quality-adjusted life-year (QALY), and life-year gained (LYG) for different treatment regimens and treatment lines (first-line, second-line, and multiple-line treatments).

Unpublished literature, including some industry-sponsored studies and reports, or non-English reports, were not included, cautioned the researchers. In addition, 2 studies were not available in the databases searched and their exclusion from the analysis might have biased their results, the team acknowledged.