Lidan Yi,1,* Qiao Liu,1,* Chongqing Tan,1 Xiaomin Wan,1 Xia Luo,1 Yinbo Li,2 Haiying Li,3 Xiaohui Zeng3 

1Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China; 2Hunan Center for Drug Evaluation and Adverse Reaction Monitoring, Hunan Provincial Food and Drug Administration, Changsha, People’s Republic of China; 3Department of Nuclear Medicine/PET Image Center, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiaohui Zeng; Haiying Li, Email zengxiaohui2008@csu.edu.cn; lihaiying2013@csu.edu.cn

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.

Keywords: cost-effectiveness, daratumumab, multiple myeloma, Markov model, China