Cost-effectiveness and budgetary impact of belantamab mafodotin as second-line or subsequent treatment for relapsed or refractory multiple myeloma (RRMM): a perspective from the Brazilian supplementary health system.
DOI:
https://doi.org/10.66305/jbas.v6i1.36Keywords:
Multiple Myeloma, Belantamab mafodotin, Isatuximabe, Daratumumab, Costs and Cost Analysis, Supplemental HealthAbstract
OBJECTIVES: To estimate the incremental cost-utility ratio (ICUR) and the budget impact associated with the adoption of belantamab mafodotin-pomalidomide-dexamethasone (BPd) compared with isatuximab-carfilzomib-dexamethasone (IsaKd) and daratumumab-carfilzomib-dexamethasone (DaraKd) in patients previously treated with at least one lenalidomide-containing regimen from the perspective of the Brazilian private (supplementary) healthcare system.
METHODS: A partitioned survival cost-effectiveness model with four health states—progression-free on treatment, progression-free off treatment, progressed disease, and death—was developed to compare BPd with IsaKd and DaraKd. Costs and health outcomes were discounted at an annual rate of 5.0%. Efficacy data for BPd were derived from the DREAMM-8 trial, while relative treatment (vs. IsaKd and DaraKd) effects were informed by a network meta-analysis. The analysis included only direct medical costs, such as drug acquisition and administration, disease monitoring, management of adverse events, and end-of-life care. Brazilian costs were obtained from official local sources (CMED and CBHPM). Scenario analyses and one-way sensitivity analyses were conducted.
RESULTS: Over a lifetime horizon, BPd proved to be a dominant strategy compared to the comparators, showing an incremental gain of 0.35 and 0.20 Quality-Adjusted Life Years (QALYs) compared to IsaKd and DaraKd, respectively. These clinical gains were accompanied by total cost savings of BRL 777,601 (IsaKd) and BRL 1,069,323 (DaraKd). In the budget impact analysis, the adoption of BPd demonstrated resource savings starting from the first year of BRL 3.2 million, reaching cumulative savings of BRL 175 million over five years.
CONCLUSIONS: BPd was found to be a dominant strategy compared with IsaKd and DaraKd for patients with RRMM treated in the second line or beyond within the Brazilian private healthcare system, providing superior clinical outcomes at a lower total cost and offering substantial potential for resource savings.
References
[1] Kumar SK, Rajkumar V, Kyle RA, et al. Multiple myeloma. Nat Rev Dis Primers 2017;3:17046. https://doi.org/10.1038/nrdp.2017.46.
[2] Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin 2023;73:17–48. https://doi.org/10.3322/caac.21763.
[3] Brasil. Ministério da Saúde. Painel Oncologia Brasil: dados epidemiológicos do câncer no Sistema Único de Saúde. 2021. https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/p/painel-oncologia-brasil (accessed January 19, 2026).
[4] Brasil. Ministério da Saúde. Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde (CONITEC). Diretrizes diagnósticas e terapêuticas do mieloma múltiplo. Brasília: Ministério da Saúde; 2023. 2026. https://www.gov.br/conitec/pt-br/midias/relatorios/2023/diretrizes-diagnosticas-terapeuticas-do-mieloma-multiplo (accessed January 19, 2026).
[5] Rajkumar SV. Multiple myeloma: 2020 update on diagnosis, risk‐stratification and management. Am J Hematol 2020;95:548–67. https://doi.org/10.1002/ajh.25791.
[6] Munshi NC, Anderson LD, Shah N, et al. Idecabtagene Vicleucel in Relapsed and Refractory Multiple Myeloma. New England Journal of Medicine 2021;384:705–16. https://doi.org/10.1056/NEJMoa2024850.
[7] Gandhi UH, Cornell RF, Lakshman A, et al. Outcomes of patients with multiple myeloma refractory to CD38-targeted monoclonal antibody therapy. Leukemia 2019;33:2266–75. https://doi.org/10.1038/s41375-019-0435-7.
[8] Moreau P, Kumar SK, San Miguel J, et al. Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group. Lancet Oncol 2021;22:e105–18. https://doi.org/10.1016/S1470-2045(20)30756-7.
[9] Hungria V, Maiolino A, Pessoa de Magalhães RJ, et al. Emerging Real-World Treatment Patterns and Clinical Outcomes of Multiple Myeloma in Argentina and Brazil: Insights from the TOTEMM Study in the Private Healthcare Sector. Current Oncology 2025;33:16. https://doi.org/10.3390/curroncol33010016.
[10] Lonial S, Lee HC, Badros A, et al. Belantamab mafodotin for relapsed or refractory multiple myeloma (DREAMM-2): a two-arm, randomised, open-label, phase 2 study. Lancet Oncol 2020;21:207–21. https://doi.org/10.1016/S1470-2045(19)30788-0.
[11] Dimopoulos MA, Beksac M, Pour L, et al. Belantamab Mafodotin, Pomalidomide, and Dexamethasone in Multiple Myeloma. New England Journal of Medicine 2024;391:408–21. https://doi.org/10.1056/NEJMoa2403407.
[12] Brasil. Ministério da Saúde. Secretaria de Ciência T e IEstratégicos. Diretrizes metodológicas: diretriz de avaliação econômica. 2014.
[13] Richter J, Beksac M. Indirect treatment comparison of belantamab mafodotin + pomalidomide + dexamethasone versus comparator regimens in lenalidomide-exposed relapsed/refractory multiple myeloma. Blood 2025;146:7567.
[14] Rozman LM. Estimativa de custos de pacientes com câncer em unidade de cuidados paliativos. 2018. Universidade de São Paulo, 2018.
[15] Chari A, Martinez-Lopez J, Mateos M-V, et al. Daratumumab plus carfilzomib and dexamethasone in patients with relapsed or refractory multiple myeloma. Blood 2019;134:421–31. https://doi.org/10.1182/blood.2019000722.
[16] Leypoldt LB, Tichy D, Besemer B, et al. Isatuximab, Carfilzomib, Lenalidomide, and Dexamethasone for the Treatment of High-Risk Newly Diagnosed Multiple Myeloma. Journal of Clinical Oncology 2024;42:26–37. https://doi.org/10.1200/JCO.23.01696.
[17] Agência Nacional de Saúde Suplementar (ANS). Sala de situação n.d. https://www.ans.gov.br/images/stories/Materiais_para_pesquisa/Perfil_setor/sala-de-situacao.html (accessed February 4, 2026).
[18] Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today – Brazil fact sheet (GLOBOCAN 2022) 2024.
[19] de Moraes Hungria VT, Martínez‐Baños DM, Peñafiel CR, et al. Multiple myeloma treatment patterns and clinical outcomes in the Latin America Haemato‐Oncology (HOLA) Observational Study, 2008–2016. Br J Haematol 2020;188:383–93. https://doi.org/10.1111/bjh.16124.
[20] Agência Nacional de Saúde Suplementar (ANS). Consulta Pública no 118, de 2 de outubro de 2023 2023.
[21] Trudel S, Beksac M, Pour L, et al. Deep responses and durable outcomes in patients treated with belantamab mafodotin plus pomalidomide and dexamethasone from long-term follow-up of the Phase 3 dreamm-8 study. Blood 2025;146:2264–2264. https://doi.org/10.1182/blood-2025-2264.
[22] Mateos M-V, Trudel S, Quach H, et al. Modification of belantamab mafodotin dosing to balance efficacy and tolerability in the DREAMM-7 and DREAMM-8 trials. Blood Adv 2025;9:5708–19. https://doi.org/10.1182/bloodadvances.2025016949.
[23] Agência Nacional de Vigilância Sanitária (ANVISA). Bula do medicamento Blenrep (belantamabe mafodotina) 2025.
[24] National Institute for Health and Care Excellence (NICE). TA695: Evidence review. 2021. https://www.nice.org.uk/guidance/ta695/evidence (accessed March 24, 2026).
[25] Attal M, Richardson PG, Rajkumar SV, et al. Isatuximab plus pomalidomide and low-dose dexamethasone versus pomalidomide and low-dose dexamethasone in patients with relapsed and refractory multiple myeloma (ICARIA-MM): a randomised, multicentre, open-label, phase 3 study. The Lancet 2019;394:2096–107. https://doi.org/10.1016/S0140-6736(19)32556-5.
[26] Hungria V, Gaiolla R, Galvez K, et al. Health care systems as determinants of outcomes in multiple myeloma: final results from the Latin American MYLACRE study. Blood Adv 2025;9:1293–302. https://doi.org/10.1182/bloodadvances.2024013838.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Straus Tanaka, Gabriel Marasco, Marcella Alemar, Marcela Antonio, Graziela Bernardino
This work is licensed under a Creative Commons Attribution 4.0 International License.
The articles published do not necessarily express the opinion of the journal and are the sole responsibility of the authors.
