Considerable data indicate post-transplant lenalidomide prolongs progression-free survival and probably survival after an autotransplant for multiple myeloma (MM). However, optimal therapy duration is unknown, controversial and differs in the EU and US. We compared outcomes and cost-effectiveness of 3 post-transplant lenalidomide strategies in EU and US settings: (1) none; (2) until failure; and (3) 2-year fixed duration. We used a Markov decision model, which included six health states and informed by published data. The model estimated the lenalidomide strategy given to failure achieved 1.06 quality-adjusted life years (QALYs) at costs per QALY gained of €29,232 in the EU and $133,401 in the US settings. Two-year fixed-duration lenalidomide averted €7,286 per QALY gained in the EU setting and saved 0.84 QALYs at $60,835 per QALY gained in the US setting. These highly divergent costs per QALY in the EU and US settings resulted from significant differences in post-transplant lenalidomide costs and 2nd-line therapies driven by whether post-transplant failure was on or off-lenalidomide. In Monte Carlo simulation analyses which allowed us to account for the variability of inputs, 2-year fixedduration lenalidomide remained the preferred strategy for improving healthcare sustainability in the EU and US settings.

中文翻译：

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自体移植来那度胺对多发性骨髓瘤患者的成本效果。

大量数据表明移植后来那度胺延长了无进展生存期，并可能延长了多发性骨髓瘤（MM）自体移植后的生存期。但是，最佳治疗的持续时间是未知的，有争议的，并且在欧盟和美国有所不同。我们比较了欧洲和美国三种3种移植后来那度胺策略的结果和成本效益：（2）直到失败；（3）2年固定期限。我们使用了一个马尔可夫决策模型，该模型包括六个健康状态，并以公开的数据为依据。该模型估计，给予失败的来那度胺策略实现了1.06质量调整生命年（QALY），在欧盟，每QALY的成本为29,232欧元，在美国为133,401美元。两年固定期限来那度胺避免€7286每在欧盟地区获得的QALY，在美国地区获得的每QALY节省了0.84个QALY，即$ 60,835 。在欧盟和美国，每个QALY的费用差异很大，这是由于移植后来那度胺成本高和移植后失败是来那度胺驱动的二线疗法的显着差异所致。在蒙特卡洛模拟分析中，我们可以考虑投入的可变性，在欧盟和美国，两年固定期来那度胺仍然是改善医疗保健可持续性的首选策略。