Economic effect of the application of three-component schemes with iksasomib or carfilsomib for therapy of multiple myeloma in adult patients
Introduction. Therapeutic options for the management of patients with multiple myeloma include innovative drugs. One of the therapeutic approaches is the use of new proteasome inhibitors – Ixazomib and Carfilzomib – which have similar indications for use in combination with lenalidomide and dexamethasone. In conditions of limited funding, one of the determining factors is the cost of therapy, thus, it is necessary to conduct a clinical and economic analysis of the use of these drugs to determine the most economically viable treatment option. Materials and methods. The study design is an analysis of the impact on the budget of using the drug Ixazomib (Ninlaro®) in combination with lenalidomide and dexamethasone compared with carfilzomib in combination with lenalidomide and dexamethasone in the city of Moscow. Target population: adult patients with recurrent and / or refractory multiple myeloma after at least one line of previous therapy. The modeling time horizon is 3 years. Two scenarios for treating patients were considered: current medical practice (without using Ixazomiba) – basic, simulated medical practice (using Ixazomiba) – alternative. The assessment of the cost of patient care was based on direct medical costs. Results. The total direct costs when using the combination with ixazazomib for 1 year amounted to about 7.1 million rubles, when using the combination with carfilzomib – more than 9.5 million rubles, while using lenalidomide with dexamethasone – more than 3.5 million rub. The use of the combination with Ixazomib is associated with lower costs for medicinal preparations, correction of undesirable effects, as well as with the absence of costs for the administration of the drug as compared with the use of the regimen with carfillosome. A gradual increase in the use of Ixazomib in combination with lenalidomide and dexamethasone during the 1st year will save more than 3.1 million rubles for the Moscow health care budget, about 5.7 million rubles for the 2nd year, during the 3rd year - about 9.9 million rubles. Conclusion The use of Ixazomib in combination with lenalidomide and dexamethasone in the treatment of patients with recurrent and / or refractory multiple myeloma after at least one therapy line is clinically effective and cost-effective within the framework of preferential drug supply in the city of Moscow.
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