Economic Evaluation of Adding Daratumumab to Carfilzomib and Dexamethasone for Relapsed or Refractory Multiple Myeloma

Objective: To assess the cost-effectiveness of adding daratumumab to carfilzomib and dexamethasone (KdD) in patients with relapsed or refractory multiple myeloma (RRMM). Materials and Methods: A Markov model was established to estimate health and economic outcomes of carfilzomib and dexamethasone (Kd) with or without daratumumab for RRMM patients over a lifetime horizon. The patients and intervention of the two arms were modeled according to the CANDOR trial. Costs were collected from the Chinese health system perspective. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to evaluate the robustness of our conclusions. Results: Compared with the Kd arm, KdD achieved an additional 0.537 quality-adjusted life-years (QALYs) at an incremental cost of $138,084, resulting in an incremental cost-utility ratios (ICURs) of $257,319 per QALY. Uncertainty analyses revealed that the model is robust to all the input parameters. Conclusion: From the Chinese healthcare system perspective, adding daratumumab to the Kd regimen for patients with RRMM appears to lack cost-effectiveness. Exploring alternative avenues such as negotiating for a more favorable price or introducing a financial assistance program dedicated to daratumumab and/or carfilzomib could prove to be an effective strategy in enhancing accessibility of this combination.