BACKGROUND: With the continuous rise in costs for oncology drugs, the Institute for Clinical and Economic Review (ICER), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have developed value-based frameworks (VBFs) to assist stakeholders in formulary and treatment decisionmaking. While emerging VBFs have the potential to significantly impact therapeutic options for patients, it is important to understand the differences associated with those VBFs within a therapeutic area. OBJECTIVE: To compare ICER, ASCO, and NCCN VBFs across three therapeutic options for relapsed or refractory multiple myeloma (RRMM).
METHODS: The values of carfilzomib (CFZ), elotuzumab (ELO), and ixazomib (IX) were generated using ICER, ASCO, and NCCN VBFs. Those regimens, used for second or third line treatment of RRMM, were chosen because they share a common comparator in clinical trials, lenalidomide + dexamethasone (LEN + DEX). The ICER 2016 report of treatment options for RRMM was used to obtain results of the comparative clinical effectiveness and the cost effectiveness analysis for those regimens compared to LEN + DEX. ASCO’s 2016 VBF, which incorporates clinical benefit, toxicity and bonus points was used to generate a net health benefit (NHB) score without a scale along with the drug wholesale acquisition cost (WAC) for each regimen compared to LEN + DEX. The NCCN VBF uses a score ranging from 1 to 5, with 1 as the least favorable and 5 as the most favorable, for each of five evidence blocks: efficacy, safety, quality, consistency, and affordability. The 2016 Multiple Myeloma NCCN evidence blocks was used to obtain the value of CFZ, ELO, and IX.
RESULTS: The ICER VBF suggested with moderate certainty that CFZ, ELO, and IX provide a better NHB in patients with RRMM compared to LEN + DEX. Second-line and third-line treatment costs per QALY for CFZ, ELO, and IX were $199,982, $427,607 and $433,794, and $238,560, $481,244, and $484,582, respectively. The ASCO VBF generated a total NHB of 28.8, 23.7 and 23.0 with a monthly WAC of $17,364, $16,032 and $20,607 for CFZ, ELO, and IX, respectively. The monthly cost of LEN + DEX was $11,616. The NCCN VBF had an efficacy score of 5, 3, and 4 for CFZ, ELO, IX, respectively. Safety, quality, consistency, and affordability scores of 3, 4, 4, and 1, respectively, were the same across regimens.
CONCLUSIONS: ICER, ASCO and NCCN VBFs suggest CFZ may be the most valued treatment out of the three regimens. However, their applicability in stakeholder’s decision-making remains unclear due to uncertainty and challenges associated with them.
Evaluating Value-Based Frameworks Used for Relapsed or Refractory Multiple Myeloma Regimens: ICER Report, ASCO Value Framework, and NCCN Evidence Blocks, JCPH, Thomas Jefferson University, Jefferson College of Population Health
Djatche, PharmD, Laurence M.; Goble, PharmD, Joseph; Chun, PharmD, Grace; and Varga, PharmD, Stefan, "Evaluating Value-Based Frameworks Used for Relapsed or Refractory Multiple Myeloma Regimens: ICER Report, ASCO Value Framework, and NCCN Evidence Blocks" (2017). College of Population Health Posters. 12.