Final Evidence Report From ICER on Three Therapies Targeting BCMA for Myeloma
Posted: Friday, June 4, 2021
The Institute for Clinical and Economic Review (ICER) recently released its Final Evidence Report assessing the comparative clinical effectiveness and value of three new treatments targeting the B-cell maturation antigen (BCMA): the approved chimeric antigen receptor (CAR) T-cell therapy idecabtagene vicleucel; the investigational CAR T-cell therapy ciltacabtagene autoleucel; and the antibody-drug conjugate belantamab mafodotin-blmf. These agents are intended for heavily pretreated patients with triple class–refractory multiple myeloma who have cycled through numerous previous lines of therapy.
In brief, the independent appraisal committee unanimously (15 to 0) determined the evidence to be adequate to demonstrate that idecabtagene vicleucel provides a new health benefit over usual care. A majority (13 to 2) found the evidence adequate to demonstrate ciltacabtagene autoleucel provides a new health benefit over usual care. In addition, a majority (10 to 5) found the evidence was not adequate to demonstrate a net health benefit of belantamab mafodotin over usual care.
After reviewing the clinical evidence and considering the treatments’ other potential benefits, disadvantages, and contextual considerations, the Midwest Comparative Effectiveness Public Advisory Council, one of ICER’s three independent evidence appraisal committees, evaluated the long-term value for these treatments. A majority of panelists found that idecabtagene vicleucel represents “low” long-term value for money. ICER did not conduct a long-term value for money vote for ciltacabtagene autoleucel because there is no announced price for the therapy. A majority of panelists found that belantamab mafodotin represents “low” long-term value for money. The cost-effectiveness results for belantamab mafodotin were considered to be relatively favorable due in part to patients discontinuing therapy because of side effects, as well as the high prices for the three-drug alternatives.
ICER’s detailed set of policy recommendations, including considerations for establishing prior authorization criteria, is available in the Final Evidence Report and in the standalone Policy Recommendations document.
