The price of daratumumab would have to decrease significantly for it to be cost effective in the first-line setting for older, transplant-ineligible patients who have multiple myeloma (MM), according to a study published in the Journal of Clinical Oncology.

Research has shown that adding daratumumab to lenalidomide and dexamethasone significantly prolonged progression-free survival in this patient population. However, because daratumumab is used indefinitely until disease progression, its cost effectiveness has remained unclear.

In this study, researchers created a Markov model to compare health care costs and clinical outcomes in transplant-ineligible patients with MM treated with first-line daratumumab compared with second-line daratumumab.

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Costs included lifetime direct health care costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).

The model showed that the cost of daratumumab would have to decrease by 67% in order for first-line use to be cost effective at a willingness-to-pay threshold of $150,000 per QALY.

First-line use of daratumumab was associated with an improvement of 0.52 QALYs and 0.66 discounted life-years, when compared with second-line use.

Both first- and second-line use had lifetime expenditures exceeding $1 million, but first-line daratumumab had an incremental cost of $322,836 that led to an ICER of $618,018 per QALY.

According to the model, median non–future-discounted overall survival was 7.5 years for first-line daratumumab, compared with 6.75 years for delayed daratumumab.

Based on these results, the researchers concluded that “…the more cost-effective strategy is reserving daratumumab for second-line use.”

However, the team also emphasized the need to lower the costs of treatment for myeloma and other cancers.

“Our results, combined with a number of prior cost-effectiveness studies that have demonstrated high ICERs for cancer drugs, reinforce the need for alternative pricing schemes in oncology, such as indication-specific pricing, value-based pricing, or a subscription model,” the researchers wrote.

Disclosures: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Patel KK, Giri S, Parker TL, Bar N, Neparidze N, Huntington SF. Cost-effectiveness of first-line versus second-line use of daratumumab in older, transplant-ineligible patients with multiple myeloma. J Clin Oncol. 2021;39(10):1119-1128. doi:10.1200/JCO.20.01849