Value in health regional issues · 2026
Cost-Minimization Analysis of Intravenous and Subcutaneous Daratumumab in Patients With Multiple Myeloma: A Societal and Healthcare System Perspective.
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Berti Giacomo, Fantelli Valentina, Temporin Francesca, Riccoboni Debora, Zambello Renato, Venturini Francesca
Аннотация
OBJECTIVES: We compared costs of daratumumab (DARA) subcutaneous (SC) versus intravenous (IV) from societal and healthcare system perspectives.
METHODS: We performed a cost-minimization analysis over 24 months using real-world weight distribution data from 304 patients treated in 2024. IV drug costs were weighted by patient distribution across 14 weight categories (6.25 kg intervals). We analyzed 4 patient scenarios (employed/unemployed, with/without caregiver) and 2 regimens (DARA-lenalidomide-dexamethasone, DARA-bortezomib-dexamethasone). Costs included drug acquisition, preparation materials, personnel time, and productivity losses. Probabilistic sensitivity analysis (10 000 Monte Carlo simulations) assessed robustness to weight distribution uncertainty. Break-even analysis identified weight thresholds at which formulations were cost equivalent.
RESULTS: Initial IV administration required 1104 minutes versus 22 minutes for SC; subsequent IV administrations required 392 minutes. Weighted average IV drug cost was €5579 versus €5652 for SC. From a societal perspective, SC generated savings of €1125 to €11 899 across all scenarios. Probabilistic analysis showed 100% probability of SC cost saving (mean €5839; 95% CI €2204-€14 317), with weight distribution uncertainty contributing only 2% of total cost variability. Break-even analysis showed IV was marginally cheaper only in patients < 68.75 kg (42.9% of cohort). From the healthcare provider perspective, SC generated higher net revenues (€308 versus €175 per administration); payer costs remained neutral (€315 per administration regardless of route).
CONCLUSIONS: SC DARA provides robust economic advantages across all regimens, patient scenarios, and time horizons. Despite marginal cost advantages for IV in less weight patients, the comprehensive clinical and operational benefits strongly support SC as the preferred administration route.
METHODS: We performed a cost-minimization analysis over 24 months using real-world weight distribution data from 304 patients treated in 2024. IV drug costs were weighted by patient distribution across 14 weight categories (6.25 kg intervals). We analyzed 4 patient scenarios (employed/unemployed, with/without caregiver) and 2 regimens (DARA-lenalidomide-dexamethasone, DARA-bortezomib-dexamethasone). Costs included drug acquisition, preparation materials, personnel time, and productivity losses. Probabilistic sensitivity analysis (10 000 Monte Carlo simulations) assessed robustness to weight distribution uncertainty. Break-even analysis identified weight thresholds at which formulations were cost equivalent.
RESULTS: Initial IV administration required 1104 minutes versus 22 minutes for SC; subsequent IV administrations required 392 minutes. Weighted average IV drug cost was €5579 versus €5652 for SC. From a societal perspective, SC generated savings of €1125 to €11 899 across all scenarios. Probabilistic analysis showed 100% probability of SC cost saving (mean €5839; 95% CI €2204-€14 317), with weight distribution uncertainty contributing only 2% of total cost variability. Break-even analysis showed IV was marginally cheaper only in patients < 68.75 kg (42.9% of cohort). From the healthcare provider perspective, SC generated higher net revenues (€308 versus €175 per administration); payer costs remained neutral (€315 per administration regardless of route).
CONCLUSIONS: SC DARA provides robust economic advantages across all regimens, patient scenarios, and time horizons. Despite marginal cost advantages for IV in less weight patients, the comprehensive clinical and operational benefits strongly support SC as the preferred administration route.