A recent cost-effectiveness analysis suggests that ruxolitinib may be more cost-effective than momelotinib for treating myelofibrosis (MF) patients with anemia who require transfusions. The findings, presented at the 16th International Congress on Myeloproliferative Neoplasms, compared the total cost of care associated with the two Janus kinase (JAK) inhibitors, revealing that the higher pharmacy costs of momelotinib outweigh its clinical benefits and lower transfusion costs.
The analysis, led by Aaron Gerds, MD, MS, from the Cleveland Clinic Taussig Cancer Institute, utilized a predictive model to compute the per-patient total cost of care over 6-month, 1-year, and 2-year periods. The model compared ruxolitinib and momelotinib, both of which inhibit the JAK/STAT pathway. Momelotinib additionally targets a pathway that can improve iron-restricted anemia.
Cost Analysis Details
The study was based on data from the SIMPLIFY-1 trial, which compared ruxolitinib and momelotinib in patients who had not previously received a JAK inhibitor. The analysis revealed a significant difference in pharmacy costs, with momelotinib being approximately $11,095 more expensive per month. While ruxolitinib was projected to incur an additional $10,854 in transfusion costs over a 6-month period, the overall cost of care still favored ruxolitinib.
Specifically, the analysis showed that at the 6-month mark, the total cost of care favored ruxolitinib by $46,388. This advantage increased to $84,239 at the 1-year mark and $144,539 at the 2-year mark.
Model Assumptions and Limitations
The model assumed that patients remained on therapy for the entire study duration or until death. The cost analysis was limited to pharmacy- and transfusion-related costs to isolate costs associated with reductions in transfusion. Other costs of care were assumed to be similar between the two treatments. Pharmacy costs were based on product label dosing and acquisition costs listed in the Micromedex Red Book.
The authors acknowledged that the model did not incorporate other clinical benefits associated with either drug, such as spleen response rate. Additionally, precise estimates for transfusion costs were not available, although alternative scenarios consistently resulted in cost savings with ruxolitinib.
Clinical Implications
The study's findings suggest that despite momelotinib's higher transfusion independence rates, the substantial reduction in pharmacy costs associated with ruxolitinib makes it a more cost-effective option for patients with myelofibrosis and anemia. The authors concluded that pharmacy costs for ruxolitinib remain favorable, even with higher overall survival rates that increase total pharmacy costs due to longer drug exposure.
