PharmacoEconomics 2011;

Bortezomib, thalidomide and lenalidomide can be aimed at treating patients with newly diagnosed multiple myeloma (both eligible and ineligible for transplantation) as well as those with relapsed or refractory disease. This review analysed the available clinical and economic data on these three drugs. Irrespective of which of the three agents is considered, the magnitude of the benefit in newly diagnosed cases (transplanted or non-transplanted) tends to be between 10 and 20 months per patient in terms of progression-free survival or survival; the survival benefit is smaller in relapsed or refractory disease. In addition, a single-institution observational analysis evaluated the outcomes in nearly 3000 consecutive patients examined between 1971 and 2006. The survival in patients diagnosed between 2001 and 2006 was longer than that observed in patients diagnosed between 1994 and 2000. This finding supports the conclusion that novel agents provide a survival improvement compared with traditional therapy. Formal cost-effectiveness studies on these three agents are still lacking. A MEDLINE search retrieved only four short papers or letters and no fulllength analysis. Hence, the cost effectiveness of these agents needs further investigation, with separate assessments of the different therapeutic settings. In a simplified analysis, we tried to contrast the average cost of treatment for each of the novel agents versus their respective benefit, expressed in quality-adjusted survival. Despite its preliminary nature, our assessment indicates that the cost effectiveness of these three agents is likely to be within commonly accepted pharmacoeconomic thresholds. Multiple myeloma is the second most frequent malignancy of the blood in Western countries after non-Hodgkin lymphoma and causes about 1% of neoplastic diseases and 13% of haematological malignancies. Patients are generally aged >60 years at the time of diagnosis, with only 2% of patients aged <40 years. The annual incidence is around 4 per 100 000 people. Excess bone marrow plasma cells, monoclonal protein, osteolytic bone lesions, renal disease and immunodeficiency are typical features of multiple myeloma. The disease is thought to progress from Approval for publication Signed Date Number of amended pages returned LEADING ARTICLE Pharmacoeconomics 2011; 29 (4): 1-17 1170-7690/11/0004-0001/$49.95/0 a 2011 Adis Data Information BV. All rights reserved.