Cost and Value Analysis of Standard Versus Rapid Daratumumab Infusion in Multiple Myeloma

Introduction: There is growing interest regarding cost and affordability of cancer care, particularly in the area of pharmaco-economics. Multiple myeloma has emerged as a model for discussion given the advances in diagnosis, treatments, and subsequent improvement in patient survival. Unfortunately the cost of myeloma therapy has also increased with the advent of novel therapies. Patients are commonly treated with multi-drug combinations that are well tolerated and significantly improve symptoms and outcome, allowing them to return to pre-disease activities. Therefore it is important to consider cost and value when developing new therapeutic strategies. Approval of Daratumumab (DARA) revolutionized the care of myeloma but long infusion times are costly and cumbersome to patients. After initial infusions are administered without infusion reactions DARA is normally infused over 3.5 hours. A recent study showed that a 90-minute infusion is feasible and well-tolerated in patients who have received two prior doses of DARA at standard infusion rates (Barr H et al. Blood 2017). We sought to evaluate the cost and value benefit to patients and payers since implementing this practice change throughout our institution.

Methods: We performed a retrospective chart review of patients who received standard DARA versus rapid infusion DARA between February to June 2018 at our institution. The utilization of rapid DARA infusion was implemented on April 24, 2018, so patients who received DARA prior to that date were categorized as pre-rapid DARA and those who received DARA after were considered post-rapid DARA. Pharmacy and billing data was reviewed for these patients and infusions.

Results: A total of 181 patients received DARA infusions over the four month time period. 48% of patients (n=86) were treated during the standard pre-rapid DARA timeframe and 52% (n=95) were treated with rapid DARA infusions once eligible. 246 total infusions were administered at standard dosing and 305 infusions were administered as rapid infusions. An average of 2 hours infusion time was saved with each rapid DARA infusion resulting in 610 hours saved over the two months since initiating the rapid treatment protocol. Based on our financial data, we predict that will translate to approximately $7000 savings for the first 6 cycles of treatment if patients are started on rapid infusion DARA with their third treatment dose.

Conclusion: There have been dramatic improvements in quality of life and survival of myeloma patients with the introduction of novel therapies. This requires clinicians to adjust their framework of care to account for cost, quality, and value as it applies to patients, providers, and payers. Our analysis shows that with two hours less infusion time both direct and indirect costs savings are achieved. This decrease in cost means less charges to the patient and payer. Therefore overall cost of DARA treatment is reduced. The savings to the patient and payer will quickly add up as patients continue on treatment until disease progression or inability to tolerate further treatment. This helps to decrease the burden of financial toxicity with prolonged treatment. It also improves opportunity cost of the patient and caregiver. With our two month data, we anticipate approximately 3500 hours of infusion time saved over twelve months. In centers with high chair utilization this can improve efficiency. Ongoing efforts should be made to provide value to patients, payers, and providers.