Cost-Effectiveness Analysis of Carfilzomib vs Bortezomib in Relapsed/Refractory Multiple Myeloma in Iran

Multiple myeloma, the second most common hematologic malignancy, primarily affects older adults. Proteasome inhibitors such as carfilzomib and bortezomib are key treatment options. Because of high costs, disease progression, and differences in drug outcomes, cost-effectiveness evaluations are crucial for healthcare policy.

A model-based cost-effectiveness study was conducted using Partitioned Survival Analysis with clinical and quality-of-life data from the ENDEAVOR trial. A societal perspective and 20-year time horizon were applied, encompassing direct medical, nonmedical, and indirect costs, refined through expert consultation. Treatment effectiveness was measured using quality-adjusted life-years (QALYs), whereas incremental cost-effectiveness ratio was applied to determine cost-effectiveness. Costs and outcomes beyond the first year were discounted annually at 5.8% and 5%, respectively. The willingness-to-pay threshold was set at $6065.57 (1 Iranian gross domestic product/capita). To address model uncertainty, tornado diagrams, 1-way sensitivity analyses, and Monte Carlo simulations were performed.

Carfilzomib was not cost-effective relative to bortezomib in treating relapsed/refractory multiple myeloma in Iran. Total treatment cost for carfilzomib reached $100 139.98 compared with $31 100.49 for bortezomib. Carfilzomib achieved higher health gains, with 3.43 QALYs vs 2.94 QALYs. However, its incremental cost was $69 039.49, yielding an incremental cost-effectiveness ratio of $139 206.61 per QALY gained.

In the treatment of relapsed/refractory multiple myeloma in Iran, Carfilzomib demonstrates greater clinical effectiveness than Bortezomib but is associated with substantially higher costs. Despite its improved health outcomes, Carfilzomib does not meet cost-effectiveness criteria at current market prices.