Cost-Effectiveness of Post-Autotransplant Lenalidomide in Persons with Multiple Myeloma

Monia Marchetti, Robert Peter Gale, Giovanni Barosi

Research output: Contribution to journalArticlepeer-review


Considerable data indicate post-transplant lenalidomide prolongs progression-free survival and probably survival after an autotransplant for multiple myeloma (MM). However, optimal therapy duration is unknown, controversial and differs in the EU and US. We compared outcomes and cost-effectiveness of 3 post-transplant lenalidomide strategies in EU and US settings: (1) none; (2) until failure; and (3) 2-year fixed duration. We used a Markov decision model, which included six health states and informed by published data. The model estimated the lenalidomide strategy given to failure achieved 1.06 quality-adjusted life years (QALYs) at costs per QALY gained of 29,232 in the EU and $133,401 in the US settings. Two-year fixed-duration lenalidomide averted 7,286 per QALY gained in the EU setting and saved 0.84 QALYs at $60,835 per QALY gained in the US setting. These highly divergent costs per QALY in the EU and US settings resulted from significant differences in post-transplant lenalidomide costs and 2nd-line therapies driven by whether post-transplant failure was on or off-lenalidomide. In Monte Carlo simulation analyses which allowed us to account for the variability of inputs, 2-year fixed-duration lenalidomide remained the preferred strategy for improving healthcare sustainability in the EU and US settings.

Original languageEnglish
Article numbere2021034
JournalMediterranean Journal of Hematology and Infectious Diseases
Issue number1
Publication statusPublished - Apr 29 2021


  • Lenalidomide
  • Multiple myeloma

ASJC Scopus subject areas

  • Hematology
  • Infectious Diseases


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