Background and importance A combination of daratumumab, bortezomib, melphalan and prednisone with daratumumab for maintenance (DVMP-D) has been authorised as a firstline treatment for patients with newly diagnosed multiple myeloma who are ineligible for stem cell transplantation (NDMM-NoT). An economic comparison of different alternatives available was performed, according to their economic impact.

Aim and objectives To develop an economic comparison among the therapeutic alternatives in NDMM.

Material and methods A bibliographic research was conducted in MEDLINE and EMBASE databases to identify treatment schemes with daratumumab, lenalidomide, bortezomib and thalidomide, or their combinations, in NDMM. Only authorised treatments used in clinical practice were selected. Efficacy was assessed as progression free survival. Randomised clinical phase II–III trials, which compared selected therapeutic alternatives in patients with NDMM-NoT, were included. Articles in Spanish or English language were selected. Costs of the first year of treatment were calculated from a National Health System perspective, using notified laboratory sale prices and including taxes (4% VAT) and a 7.5% rebate (in accordance with the national Royal Decree Law 8/2010). Associated direct costs in the first year were added. Incremental costs of each therapeutic alternative with respect to the reference was quantified. DVMP-D was taken as the reference in the cost incremental study.

Results Results of the systematic review included 593 studies. Nine trials were selected which analysed seven drug combinations: DVMP-D; bortezomib+melphalan+prednisone (VMP); melphalan+prednisone+thalidomide with thalidomide for maintenance (MPT-T); lenalidomide+dexamethasone for maintenance (RD); lenalidomide+dexamethasone for 18 cycles (RD18); melphalan+thalidomide+prednisone (MTP); and bortezomib+lenalidomide+dexamethasone with lenalidomide+dexamethasone for maintenance (VRD-RD). Daratumumab+lenalidomide+dexamethasone with daratumumab for maintenance was excluded for non-use by the National Health System (combination not funded). A visit to outpatients was estimated at 167€, according to the bibliography. Treatment costs for the first year were: DVMP-D 184 214€; VMP 44 435€; MPT-T 44 435€; RD 81 520€; RD18 81 520€; MTP 77 209€; and VRD-RD 104 850€. Regarding incremental costs, the most expensive scheme was the reference treatment (DVMP-D), followed by VRD-RD (−79 364€). The cheapest combination was MPT-T (−164 094€), followed by VMP (−139 779€).

Conclusion and relevance There are seven treatments, including daratumumab, lenalidomide, bortezomib and thalidomide for NDMM-NoT. The most expensive schemes for the first year of treatment are DVMP-D and VRD-RD; and the cheapest combinations are MPT-T and VMP.

References and/or acknowledgements None.

No conflict of interest.