TREATMENTS FOR NEWLY-DIAGNOSED MULTIPLE-MYELOMA - ANALYSIS OF SURVIVAL-DATA AND COST-EFFECTIVENESS EVALUATION

The main therapeutic options currently available to induce remission i n newly diagnosed cases of multiple myeloma include: i) melphalan at c onventional doses without concurrent administration of interferon; ii) melphalan at conventional dose combined with interferon; iii) autolog ous bone marrow transplantation (ABMT). We conducted an analysis of th e survival data reported in five large-scale published clinical trials and we evaluated the cost-effectiveness ratio. We determined the mean lifetime survival (MLS) for each treatment group using the Gompertz m odel. The cost data of patients given ABMT or standard chemotherapy we re estimated from published information. The values of MLS were 3.47 y ears per patient for melphalan at conventional doses without interfero n, 3.74 years for melphalan at conventional doses combined with interf eron, and 7.28 years for ABMT. As compared with conventional melphalan treatment, ABMT yielded a significantly better survival. Survival aft er melphalan combined with interferon was not significantly different from that following melphalan alone. Using melphalan at conventional d oses without interferon as reference term, the marginal cost-effective ness ratio of ABMT was of about $26,000 per life year gained. For the induction treatment in patients with newly diagnosed myeloma, ABMT see ms to be more effective and more cost-effective than the standard trea tment with melphalan at conventional doses.