{"data":{"id":"10.6084/m9.figshare.c.2129678","type":"dois","attributes":{"doi":"10.6084/m9.figshare.c.2129678","prefix":"10.6084","suffix":"m9.figshare.c.2129678","identifiers":[],"alternateIdentifiers":[],"creators":[{"name":"Borg, Sixten","nameType":"Personal","givenName":"Sixten","familyName":"Borg","affiliation":[],"nameIdentifiers":[]},{"name":"Hareth Nahi","affiliation":[],"nameIdentifiers":[]},{"name":"Hansson, Markus","nameType":"Personal","givenName":"Markus","familyName":"Hansson","affiliation":[],"nameIdentifiers":[]},{"name":"Lee, Dawn","nameType":"Personal","givenName":"Dawn","familyName":"Lee","affiliation":[],"nameIdentifiers":[]},{"name":"Elvidge, Jamie","nameType":"Personal","givenName":"Jamie","familyName":"Elvidge","affiliation":[],"nameIdentifiers":[]},{"name":"Persson, Ulf","nameType":"Personal","givenName":"Ulf","familyName":"Persson","affiliation":[],"nameIdentifiers":[]}],"titles":[{"title":"Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden"}],"publisher":"Figshare","container":{},"publicationYear":2015,"subjects":[{"subject":"Medicine"},{"subject":"Pharmacology"},{"subject":"Sociology"},{"subject":"FOS: Sociology","schemeUri":"http://www.oecd.org/science/inno/38235147.pdf","subjectScheme":"Fields of Science and Technology (FOS)"},{"subject":"FOS: Sociology","subjectScheme":"Fields of Science and Technology (FOS)"},{"subject":"69999 Biological Sciences not elsewhere classified","subjectScheme":"FOR"},{"subject":"FOS: Biological sciences","schemeUri":"http://www.oecd.org/science/inno/38235147.pdf","subjectScheme":"Fields of Science and Technology (FOS)"},{"subject":"FOS: Biological sciences","subjectScheme":"Fields of Science and Technology (FOS)"},{"subject":"Science Policy"}],"contributors":[],"dates":[{"date":"2015-12-05","dateType":"Created"},{"date":"2016-04-28","dateType":"Updated"},{"date":"2015","dateType":"Issued"}],"language":null,"types":{"ris":"GEN","bibtex":"misc","citeproc":"article","schemaOrg":"Collection","resourceType":"Collection","resourceTypeGeneral":"Collection"},"relatedIdentifiers":[],"relatedItems":[],"sizes":[],"formats":[],"version":null,"rightsList":[{"rights":"CC-BY","rightsUri":"http://creativecommons.org/licenses/by/3.0/us"}],"descriptions":[{"description":"\u003ci\u003eBackground\u003c/i\u003e: Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. \u003ci\u003eMaterial and methods\u003c/i\u003e: We developed a health-economic discrete event simulation model of a patient’s course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature. \u003ci\u003eResults\u003c/i\u003e: The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (€19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (€81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (€62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental cost-effectiveness ratio is SEK 798 613 (€84 900) per QALY gained. \u003ci\u003eConclusion\u003c/i\u003e: In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.","descriptionType":"Abstract"}],"geoLocations":[],"fundingReferences":[],"xml":"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