Cost-effectiveness bortezomibe in first, second and third line in multiple myeloma using health economic modeling

Abstract

INTRODUCTION: Multiple myeloma is a rare neoplasm with only a few therapeutic options, especially for patients not eligible to Bone Marrow Transplant. Bortezomib, a proteasome inhibitor, is an important option with significant clinical results in the treatment of first line multiple myeloma as well as in refractory disease. OBJECTIVE: To evaluate the cost-effectiveness of bortezomib used as first, second or third line treatment for multiple myeloma, under the perspective of the Brazilian Public Health Care system. METHODS: The models were developed based on the results of the pivotal randomized clinical trials of bortezomib, considering also open follow-up studies. A lifetime horizon was considered for the analyses. RESULTS: The use of bortezomib as first line treatment demonstrated to be cost-effective resulting in an incremental cost-effectiveness ratio (ICER) of R$26.668 per life year gained when compared to MP. In second and third line, bortezomib resulted in an ICER of R$52.357 and R$ 57.284 respectively, when compared to dexamethasone. CONCLUSIONS: The anticipated use of bortezomib represents not only an important option to patients but also to payers.