Objectives: To evaluate the budget impact of introducing panobinostat combined with bortezomib-dexamethasone (FVD) in 3rd/4thline of treatment (LT) of relapsed/refractory multiple myeloma (RRMM) to the Greek public healthcare system (NHS). Methods: Disease management for RRMM was collected based on DELPHI methodology using an expert panel consisting of seven hematologists from public hospitals around Greece. According to the expert panel, from 2,000 people with MM in Greece, 75% have RRMM, 15% (n= 300) receive 3rdLT and 10% (n= 200) 4thLT. Based on clinical practice, disease management consists of bortezomib- dexamethasone (VD), cyclophosphamide-bortezomib-dexamethasone and pomalidomide-dexamethasone (PomDex) in 3rdLT and PomDex, thalidomide-dexamethasone, cyclophosphamide-prednisone, thalidomide-dexamethasone-cisplatin- doxorubicin-cyclophosphamide-etoposide (DT-PACE) in 4thLT. Direct medical costs per treatment line and regimen were included (pharmaceutical, medical and hospital care, lab and imaging tests, prophylactic treatment, and management of adverse events) reflecting 2016 cost in Euros based on national reimbursed prices and DRGs tariffs. The total cost for each treatment regimen, was calculated based on the median treatment duration (mTD), for which two scenarios were considered: a) mTD as obtained from literature and b) adjusted mTD in order to achieve 12 months of progression-free-survival (PFS). Results: The cost per month-without- progression for FVD is € 3,598, achieving 12-months of PFS only with a mTD of 5-months, whereas its comparators require much longer mTD to gain the same PFS. The introduction of FVD in 3rdLT costs € 5,552 per patient/year while the respective cost in 4th LT is € 10,602 per patient/year. Additionally, when adjusted mTDs were considered for all therapeutic options in order to achieve 12 months of PFS, the cost of FVD was estimated at € 4,324 and € 6,082 per patient/year in 3rd and 4thLT, respectively. Conclusions: In both lines and scenarios, FVD is a value for money option. The budget impact, on Greek NHS, is lower when FVD is considered for patients who are at 3rd treatment line of RRMM.
Vellopoulou, K., Kourlaba, G., Delimpasi, S., Chatzikou, M., Katodritou, E., Konstantopoulou, K., … Terpos, E. (2016). Budget Impact Analysis of Panobinostat – Bortezomib and Dexamethasone, As 3rd Or 4th Line of Treatment in Patients with Relapsed/Refractory Multiple Myeloma in Greece. Value in Health, 19(7), A729. https://doi.org/10.1016/j.jval.2016.09.2189