This ebook from IHS compares the actual cost (minus administration costs) of bortezomib monotherapy treatment versus lenalidomide / dexamethasone therapy in second-line Multiple Myeloma in the United States and United Kingdom.

1. A Cross-country Cost Comparison
of Second-Line Multiple Myeloma Treatments
D E V E LO P E D B Y:
Sophia Walker
Gustav Ando
Milena Izmirlieva
Praful Mehta

2. Contents
Purpose .......................................................................... 3
Methodology .................................................................. 4
Assumptions................................................................... 5
Results ........................................................................... 6
Conclusions .................................................................... 8
Meet the Analysts ......................................................... 10
2 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

3. Purpose
The standard of care for second-line multiple myeloma This study seeks to compare the actual cost (minus
(MM) treatment includes both bortezomib monotherapy administration costs) of bortezomib monotherapy treatment
treatment, an injectable, and lenalidomide/dexamethasone, versus lenalidomide/dexamethasone therapy in second-line
both capsules. However, the difference in treatment cost MM in the United States and United Kingdom.
of each therapy has not been well established.
3 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

4. Methodology
The IHS OncoInsight Market Access Database was Cost Calculations
reviewed to find the ex-manufacturing package price and To derive the cost curve across pooled treatment regimes,
price per mg of each drug. All prices were from H1 2010. the cost calculations were performed for 95% confidence
interval ranges of all the recorded TTP values in the clinical
Dosing and Treatment Duration trials. For more details on the various TTP values used to
Dosing schedules were followed as stipulated in the clinical project the cost curve, please refer to the clinical trial protocol
trial documents. According to the clinical information for bortezomib and lenalidomide/dexamethasone.
provided in the label, lenalidomide/ dexamethasone was to
be stopped at treatment progression, therefore the duration Cost calculations were based on total dosage in mg
of use was derived from time-to-progression (TTP) figures. multiplied by cost per mg.
For bortezomib monotherapy, the duration of use was
extracted from the label, which specified that the mean
number of doses during the APEX study was 22.
In order to identify the treatment landscape fully, dose ranges
were derived from the respective labels. For each treatment,
based on the range of TTP in months, the total number of
treatment cycles and thus total dosage in mg were identified.
4 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

5. Assumptions
ƒ Number of days in a month: 30.416 ƒ Average body surface area: 1.75 m2
(365 days/12 months).
ƒ Price based on pack size of 3.5-mg vial for bortezomib,
ƒ Average dosage ranges for bortezomib monotherapy and a pack size of 25 tablets of 25 mg each in the US
based on the assumption that patients were taken and 25 tablets of 21 mg each in the UK for lenalidomide.
off treatment at progression, although not stipulated
in the label. ƒ Exchange rate based on IHS Global Insight’s proprietary
exchange-rate figures for 2010: GBP1.00:USD1.54
ƒ Calculation based on the assumption that patients Additionally, HTA decisions on the drugs were identified.
received the unmodified dose of the drug, excluding
any dosing changes in response to clinical and
laboratory findings undertaken in the clinical study
described in the label.
5 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

6. Results
Harmonised Cost Comparison Using the highest number of doses documented in the
Based on the median TTP, the total average treatment APEX study (44), the totals come to USD34,091.06 and
cost for the lenalidomide/dexamethasone treatment was GBP19,416.4 (USD29,901.26). In order to harmonise the com-
USD101,052.75 in the US and GBP58,926.78 (USD 90,747.24) parison, we also calculated total dosage at median TTP
in the UK. Based on an average total dosage of 22, the total values of 6.2 months for bortezomib. The resulting values
average treatment costs of bortezomib monotherapy were were USD27,892.68 and GBP15,886.14 (USD24,464.66). At a
USD17,045.53 in the US and GBP9,708.2 (USD14,950.63) constant exchange-rate basis, both treatments were relatively
in the UK. more expensive in the US than the UK.
Dosing Curves for lenalidomide+ dexamethasone in Multiple Myeloma Dosing Curves for bortezomib in Multiple Myeloma
35000 120
30000 15046.0
100.1
100
81.90 84.18 86.45
25000
11623.1 80
20000 10283.7 65.98
8349.0 60 56.88
15000 10550.6
10000 6900.6 7927.2 40
5417.9
5000 4495.4 20
2931.2 3383.0 3695.9 8.8
4.2 4.9 6.2 6.3 6.9
0 9.5 12.1 13.9 18.5 0
1 2 3 4 1 2 3 4 5 6
TTP Values in Months Total dexamethasone (mg)
Total lenalidomide (mg) Total len + dex (mg) TTP Values in Months Total Mg of bortezomib (mg)
Dosing Curves for lenalidomide/dexamethasone in Multiple Myeloma Dosing Curves for bortezomib in Multiple Myeloma
6 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

7. Results (continued)
Cost Curves for lenalidomide+ dexamethasone and bortezomib in Multiple
Myeloma in the UK and US
$350,000
$300,000 $134,344
$250,000
$101,054
$200,000 $88,028
$69,212 $120,743
$150,000
$90,745
$100,000 $79,006
$62,051
$50,000 $27,892.68 $28,667 $29,442 $34,091
$17,046 $19,370 $22,469 $25,824 $29,901
$14,951 $16,989 $19,708 $24,464.66 $25,144
$0
Series 1 Series 2 Series 3 Series 4 Series 5 Series 6 Series 7
Total Cost of bortezomib - UK ($) Total Cost of bortezomib - US ($)
Total Cost of len + dex - UK ($) Total Cost of len + dex - US ($)
Cost Curves for lenalidomide/dexamethason and bortezomib in Multiple Myeloma in the UK and US
7 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

8. Conclusion
The research suggests that in both the US and UK, NICE guidance officially and unofficially affects
treatment (minus administration) costs with bortezomib pharmacoeconomic analysis in other countries, particularly
is significantly lower than lenalidomide/ dexamethasone. in the EU, meaning that NICE’s decisions on post first-line
Additionally, both treatments were found to be less MM treatments could have significant implications for
expensive in the UK. These findings are aligned with NICE’s other markets deciding whether and how to reimburse
decision to position bortezomib ahead of lenalidomide/ these treatments.
dexamethasone in the treatment sequence. However,
the fact that both treatments relied on a PAS to receive Both treatments have been established as standard-of-
approval suggests that the costs for both are outside care treatments for second-line MM; however, best practice
acceptable parameters, at least in the UK setting, and has not yet been determined. Cost is certainly not the only
despite the UK being a free-priced market, our analysis factor in determining if, when, and how a drug should be
has shown that it is a relatively low-cost one. used, although it is a vital component. By having a better
understanding of the difference in cost, payors can
make more informed decisions about how to prioritise
MM treatment.
8 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

9. References
1. Bortezomib label:
http://www.velcade.com/Files/PDFs/VELCADE_PRESCRIBING_INFORMATION.pdf
accessed on 10 January 2011
2. Lenalidomide label:
http://revlimid.com/pdf/REVLIMID_PI.pdf
accessed on 6 January 2011
3. NICE guidance on bortezomib:
http://www.nice.org.uk/nicemedia/live/11869/38001/38001.pdf
accessed on 6 January 2011
4. NICE guidance on lenalidomide:
http://www.nice.org.uk/nicemedia/live/11898/44812/44812.pdf
accessed on 6 January 2011
5. UK pricing and reimbursement data taken from the IHS OncoInsight Market Access
Database, accessed on 5 January 2011
9 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

10. Meet the Analysts
Gustav Ando Sophia Walker
Director, Healthcare and Pharma, IHS Senior Healthcare Analyst, IHS
Gustav Ando leads the Healthcare and Pharma Sophia Walker is a Senior Analyst in the advanced
Practice at IHS. Formerly a healthcare analyst, he markets team, with a focus on the oncology
has extensive experience in the fields of market service. She has an extensive background in
access, therapeutic development, drug safety, oncology clinical trials, as well as an expertise in
emerging markets and health outcomes. market access and pricing and reimbursement.
Milena Izmirlieva Praful Mehta
Senior Manager, Healthcare and Pharma, IHS Senior Healthcare Analyst, IHS
Milena Izmirlieva is a Senior Manager in the Praful Mehta is a practice leader within the
Healthcare and Pharma practice at IHS. Her IHS therapeutic area services. Praful has been a
areas of expertise include market access, pricing long-time advisor to senior tea ms within
and reimbursement, generics and biosimilars, the pharma industry on issues of market
corporate strategies, and pharma promotion competitiveness, business integration and
and advertising. commercialization strategies.
10 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

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11 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.