Cost of Anti-CD38 Monoclonal Antibodies in Combination With Bortezomib, Lenalidomide and Dexamethasone for the Frontline Treatment of Transplant-Ineligible Patients With Newly Diagnosed Multiple Myeloma in the US

Background: The efficacy of the combination of bortezomib, lenalidomide, and dexamethasone with daratumumab (DVRd) or isatuximab (IsaVRd) for the frontline treatment of transplant-ineligible (TIE) newly diagnosed multiple myeloma (NDMM) has been demonstrated in clinical trials. However, the treatment cost for DVRd and IsaVRd has not been compared. Objectives: To compare the drug acquisition costs (DAC) of DVRd vs IsaVRd in the first 2 years of frontline treatment for TIE patients with NDMM in the United States. Methods: Dosing schedules from the CEPHEUS and IMROZ clinical US trials were used for this analysis. AnalySource® was utilized to access the First Databank drug pricing database to collect current US DACs. Drug administration time and costs were identified and weighted, assuming 40% and 60% received the drug in a hospital outpatient and community oncology setting, respectively. Total costs were calculated by adding DACs and drug administration costs. Results: The DAC was $200 866 in year 1 and $137 434 in year 2 for daratumumab and $212 421 in year 1 and $144 143 in year 2 for isatuximab. The DAC of daratumumab was $18 264 (5.4%) less than isatuximab across year 1 and 2. In year 1, the total cost of DVRd per patient was $17 269 and $17 327 less than IsaVRd in patients <75 years and ≥75 years old, respectively. In year 2, the total cost of DVRd per patient was $10 444 and $10 553 less than IsaVRd in patients <75 years and ≥75 years old, respectively. Across years 1 and 2, total cost of DVRd per patient was $27 713 and $27 880 less than IsaVRd in patients <75 years and ≥75 years old, respectively. Compared with isatuximab, treatment with daratumumab saves 36.13 and 22.17 hours of administration time in the first and second year, respectively. Discussion: This analysis shows that the DAC of DVRd is less than IsaVRd for the frontline treatment of TIE NDMM patients. DVRd results in time savings vs IsaVRd, which is preferable for patients and caregivers. Conclusions: DVRd is a timesaving and less expensive frontline treatment option for patients with TIE NDMM than IsaVRd in the first and second year of treatment.