Cost Comparison of Ruxolitinib and Momelotinib in Patients with Myelofibrosis and Anemia

Introduction: Approximately 60% of patients with myelofibrosis (MF) are anemic, and 25% are transfusion-dependent at diagnosis. Ruxolitinib and momelotinib are both indicated for treatment of intermediate or high-risk MF in patients with anemia. The objective of this analysis was to estimate if the clinical benefit of momelotinib in transfusion reduction led to savings in the cost of care compared with ruxolitinib in patients with MF and anemia.

Methods: A cost-comparison model was developed to compare patients with MF and anemia who are Janus kinase inhibitor-naive and treated with either ruxolitinib or momelotinib. The model used an initial decision tree analysis followed by a partition-survival analysis and assessed costs at 6 months, 1 year, and 2 years of treatment with 6-month cycles, with the assumption that patients remained on therapy for the entire duration or until death. Rates of transfusion independence after initial treatment with ruxolitinib or momelotinib were sourced from the SIMPLIFY-1 clinical trial and drove the decision tree analysis. The subsequent partition-survival analysis is based on survival curves from the corresponding transfusion-independent and transfusion-dependent populations in SIMPLIFY-1 for momelotinib, and COMFORT-I/COMFORT-II (anemia subgroup) for ruxolitinib. Transfusion-related costs per 6 months were sourced from a claims analysis of transfusion in MF patients. Pharmacy costs were based on dosing from product labels, and published wholesale acquisition costs were sourced from Micromedex Red Book®. To isolate costs associated with reductions in transfusion, the model was limited to pharmacy costs and transfusion-related costs, with other costs of care assumed similar between ruxolitinib and momelotinib treatment. Results were presented on a per-patient basis.

Results: Patients treated with ruxolitinib incurred $101,996 in pharmacy costs at 6 months, $200,810 at 1 year, and $380,077 at 2 years, along with $32,828 in transfusion costs at 6 months, $64,545 at 1 year, and $122,068 at 2 years, for total costs of $134,824, $265,355, and $502,145, respectively. At identical time points, patients treated with momelotinib incurred pharmacy costs of $159,238, $307,841, and $572,064, respectively, and transfusion costs of $21,974, $41,753, and $74,620, for total costs of $181,212, $349,594, and $646,684. Compared with momelotinib, ruxolitinib is cost-saving at each time point, with $46,388 saved at 6 months, $84,239 at 1 year, and $144,539 at 2 years. The results of the model suggest for ruxolitinib that any increase in transfusion costs was offset by a larger reduction in pharmacy costs. Higher transfusion independence rates among momelotinib patients drove the differences in transfusion costs. Pharmacy costs for ruxolitinib remain favorable compared with momelotinib despite incorporating higher overall survival rates associated with ruxolitinib, which increase total pharmacy costs due to longer drug exposure. One limitation of this model is the lack of precise estimates of transfusion costs; however, analyses with alternate estimates for transfusion costs varied the magnitude but consistently resulted in cost savings with ruxolitinib. In addition, due to the lack of accurate data in total cost of care, this model did not incorporate other clinical benefits associated with either ruxolitinib or momelotinib, including symptom response rate, spleen response rate, and potential secondary benefits of lower transfusion need, which are also important considerations in addition to cost.

Conclusions: The model predicts substantial per-patient cost savings with ruxolitinib due to its lower pharmacy costs, which offset estimated higher transfusion costs, and suggests the clinical transfusion benefit of momelotinib does not lead to savings in the cost of care.

Gerds:Agios: Consultancy; Disc Medicine: Consultancy; PharmaEssentia: Consultancy; Rain Oncology: Consultancy; GSK: Consultancy; AbbVie: Consultancy; BMS: Consultancy. Yu:Incyte Corporation: Current Employment, Current holder of stock options in a privately-held company. Tao:Incyte: Consultancy; Cencora, Inc: Current Employment, Current holder of stock options in a privately-held company. Carlton:Incyte: Consultancy; Cencora, Inc: Current Employment, Current holder of stock options in a privately-held company. Braunstein:Incyte Corporation: Current Employment, Current equity holder in publicly-traded company. Mesa:La Jolla Pharma: Consultancy; Incyte: Consultancy, Research Funding; Novartis: Consultancy; Sierra Oncology: Consultancy, Research Funding; BMS: Consultancy, Honoraria; Genentech: Research Funding; Abbvie: Research Funding; AOP Orphan Pharmaceuticals: Consultancy; Celgene: Research Funding; CTI Biopharma: Research Funding; Gilead: Research Funding.