Saturday, July 13, 2024

Economic Models for Multiple Myeloma Treatments: A Systematic Review

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Multiple myeloma, an incurable hematological cancer, poses significant challenges due to frequent relapses and treatment resistance. Understanding the economic implications of systemic treatments for relapsed/refractory multiple myeloma is critical for developing effective healthcare strategies. This systematic review dissects existing economic models, focusing on their methodologies, the consideration of treatment lines, and the handling of prior treatment exposures.

A comprehensive literature search was conducted on February 17, 2023, across databases to identify models published from 2014 onwards. Additionally, key health technology assessment agency websites were manually searched for models since 2018. The review aimed to extract and analyze information on model conceptualization, structure, uncertainty, validation, and transparency.

Methodological Approaches in Economic Models

The review included 49 models that evaluated a variety of interventions across different therapy lines. Notably, only five models focused on heavily pre-treated patients or those resistant to multiple treatment classes. Conventional methodologies dominated, with partitioned survival models (28 instances) and Markov models (9 instances) being the most common. These models typically assessed specific interventions rather than entire treatment sequences.

Subsequent therapies, when included, were mainly evaluated from cost and resource use perspectives. Common model inputs included overall and progression-free survival rates, although the data used were often immature. Sensitivity analyses were frequently reported, with 41 models incorporating them, while validation was considered in less than half of the models (19 instances).

Challenges and Future Directions

The review highlighted a gap in individual patient approaches in published economic models, largely due to the complexity and extensive data requirements of such methodologies. As patients often undergo multiple treatment lines, there is an emerging need for more advanced modeling strategies. Future models must embrace complexity to better reflect real-world scenarios and treatment sequences.

Transparency and high reporting standards are essential for the advancement of economic models in this field. Thorough analyses of uncertainty and validation processes are crucial to enhance the reliability and applicability of these models in clinical decision-making.

Key Inferences for Stakeholders

– Economic models should evolve to include more sophisticated approaches that account for multiple treatment lines.
– Transparency in model reporting and validation processes is critical to ensure reliability.
– Sensitivity analyses should be comprehensive to address the uncertainties inherent in economic evaluations.
– Future research must prioritize developing models that reflect real-world treatment sequences and patient experiences.

The findings underscore the necessity for advanced economic models to support decision-making in the treatment of relapsed/refractory multiple myeloma. As the disease often progresses through various treatment phases, the development of more intricate models will be pivotal in optimizing therapeutic strategies and resource allocation.

Original Article: Pharmacoeconomics. 2024 Jun 25. doi: 10.1007/s40273-024-01399-3. Online ahead of print.

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