Cost-effectiveness analysis of elranatamab versus physician's choice of treatment (non-BCMA-directed regimens) in patients with triple class exposed multiple myeloma in Japan.
To evaluate the cost-effectiveness of elranatamab versus physician's choice of treatment (PCT) for patients with triple class exposed multiple myeloma in Japan.
A cost-effectiveness analysis was conducted comparing elranatamab with PCT using a partitioned survival model with three health states from the Japanese public healthcare payer perspective. A weekly cycle length and a 25-year lifetime horizon were applied, with costs and health outcomes discounted at 2% annually in accordance with Japanese HTA guidelines. Clinical inputs for elranatamab were derived from the phase 2 MagnetisMM-3 trial. Comparative effectiveness versus PCT was estimated using an unanchored matching-adjusted indirect comparison (MAIC) with the prospective real-world LocoMMotion study. Utility values were calculated by applying the Japanese value set to EQ-5D-5L data collected in MagnetisMM-3. Scenario analyses were performed using MAIC-based comparisons versus teclistamab and idecabtagene vicleucel (ide-cel).
In the base-case analysis, elranatamab increased quality-adjusted life-years (QALYs) compared with PCT (2.59 vs 0.82) at a higher total cost (JPY 36,901,695 (USD 246,570) vs 30,899,696 (USD 206,466)), resulting in an incremental cost of JPY 6,001,999 (USD 40,104) and an incremental QALY gain of 1.77. The incremental cost-effectiveness ratio (ICER) was JPY 3,394,966 (USD 22,684) per QALY, remaining within cost-effectiveness thresholds in Japan. Sensitivity analyses demonstrated the robustness of the base-case results. In scenario analyses, elranatamab was dominant versus teclistamab and ide-cel.
Limitations include reliance on the clinical opinion of a single hematology expert for Japanese clinical practice patterns, extrapolation beyond observed trial follow-up, and inherent constraints of MAIC due to the lack of head-to-head trials.
From the healthcare payer perspective, elranatamab was cost-effective versus PCT in the base case and scenario analyses, with ICERs consistently below commonly accepted thresholds in Japan; contingent on the unanchored MAIC and long-term extrapolation, this should be interpreted with caution.
A cost-effectiveness analysis was conducted comparing elranatamab with PCT using a partitioned survival model with three health states from the Japanese public healthcare payer perspective. A weekly cycle length and a 25-year lifetime horizon were applied, with costs and health outcomes discounted at 2% annually in accordance with Japanese HTA guidelines. Clinical inputs for elranatamab were derived from the phase 2 MagnetisMM-3 trial. Comparative effectiveness versus PCT was estimated using an unanchored matching-adjusted indirect comparison (MAIC) with the prospective real-world LocoMMotion study. Utility values were calculated by applying the Japanese value set to EQ-5D-5L data collected in MagnetisMM-3. Scenario analyses were performed using MAIC-based comparisons versus teclistamab and idecabtagene vicleucel (ide-cel).
In the base-case analysis, elranatamab increased quality-adjusted life-years (QALYs) compared with PCT (2.59 vs 0.82) at a higher total cost (JPY 36,901,695 (USD 246,570) vs 30,899,696 (USD 206,466)), resulting in an incremental cost of JPY 6,001,999 (USD 40,104) and an incremental QALY gain of 1.77. The incremental cost-effectiveness ratio (ICER) was JPY 3,394,966 (USD 22,684) per QALY, remaining within cost-effectiveness thresholds in Japan. Sensitivity analyses demonstrated the robustness of the base-case results. In scenario analyses, elranatamab was dominant versus teclistamab and ide-cel.
Limitations include reliance on the clinical opinion of a single hematology expert for Japanese clinical practice patterns, extrapolation beyond observed trial follow-up, and inherent constraints of MAIC due to the lack of head-to-head trials.
From the healthcare payer perspective, elranatamab was cost-effective versus PCT in the base case and scenario analyses, with ICERs consistently below commonly accepted thresholds in Japan; contingent on the unanchored MAIC and long-term extrapolation, this should be interpreted with caution.
Authors
Yuasa Yuasa, Nagano Nagano, Kamei Kamei, Hatsuyama Hatsuyama, Matsuda Matsuda, Hlavacek Hlavacek, DiBonaventura DiBonaventura, Suzuki Suzuki
View on Pubmed