Administration- and adverse event-related costs among patients with multiple myeloma treated with B-cell maturation antigen (BCMA)-targeted agents

Abstract

Abstract Introduction: Costs associated withadministration and adverse events (AEs) are important considerations in budget impact models (BIMs) of anti-cancer therapies. Anti-BCMA antibody-drug conjugates (belantamab mafodotin [belamaf]), chimeric antigen receptor T-cell therapies (CAR-T; ciltacabtagene autoleucel [cilta-cel], idecabtagene vicleucel [ide-cel]), and bispecifics (teclistamab) for relapsed/refractory multiple myeloma (RRMM) vary in modes of administration and AE burden; characterizing associated costs may support payer decision making. The study aimed to compare administration and AE-related costs of belamaf regimens with those of other anti-BCMA agents using BIM. Methods: A 3-year BIM was developed to evaluate administration and AE-related costs for patients with RRMM and ≥1 prior line of therapy who had received belamaf plus bortezomib and dexamethasone (BVd), belamaf plus pomalidomide and dexamethasone (BPd), cilta-cel, ide-cel, or teclistamab. Administration costs included office visits, drug delivery, label-required hospitalization, premedication (including intravenous immunoglobulin), and for CAR-T, leukapheresis and bridging therapies sourced from published protocols, labels, or clinician input. Administration-related unit costs were sourced from the 2025 Medicare Physician Fee Schedule, Medicare Procedure Price lookup for leukapheresis, literature for hospitalization costs, and Medi-Span Price Rx for wholesale acquisition costs for drug costs. BVd/BPd dosing was obtained using weekly individual patient dosing data from DREAMM-7/DREAMM-8 trials (means of 9/7/6 doses for BVd and 6/3/3 doses for BPd in Years 1/2/3) and cilta-cel/ide-cel/teclistamab dosing from published prescribing information. AE-related costs included grade ≥3 AEs with ≥5% incidence, as well as grade ≥2 ocular AEs (oAEs) for belamaf obtained from clinical trial publications. Grade ≥2 cytokine release syndrome (CRS) for CAR-T/bispecific therapies was included with an assumption that costs of treating CRS of Grade 2 or 3 are the same on average. Median durations of treatment input into the BIM were obtained from Kaplan-Meier analyses of second-line or later clinical trials for BVd (17.3 months), BPd (20.0 months), and cilta-cel (45.4 months), and from third-line or later clinical trials for teclistamab (8.5 months) and ide-cel (13.3 months); use of third-line or later clinical trials for median duration of therapy may have impacted on the estimated costs. The costs associated with treatment of AEs were based on Healthcare Cost and Utilization Project data for inpatient treatment. The assessment was conducted from a Medicare plan perspective, with costs (in 2025 USD) annualized over 3 years and reported as mean costs per patient. Results: Three-year cumulative administration costs were $1,699 (BVd), $1,024 (BPd), $67,119 (teclistamab), $103,625 (ide-cel), and $103,625 (cilta-cel). The most common grade ≥3 AEs were thrombocytopenia (55%/38%) and neutropenia (12%/57%) for BVd/BPd, and neutropenia (64%/76%/90%) and thrombocytopenia (21%/42%/41%) for teclistamab/ide-cel/cilta-cel. Grade ≥2 oAEs occurred in 81%/82% with BVd/BPd. Grade ≥2 CRS occurred in 22% (teclistamab)/32% (ide-cel)/23% (cilta-cel). AE-related costs were $19,396 (BVd), $24,168 (BPd), $51,216 (teclistamab), $83,521 (ide-cel), and $62,292 (cilta-cel). Alternative assumptions and sensitivity analyses were explored.Conclusions: BVd/BPd had substantially lower administration and AE-related costs vs CAR-T and bispecific therapies, which have high costs mostly due to hospitalizations, premedication, and CRS rates.