Real-world cost-effectiveness of sequential therapy of in-class transition to ixazomib versus daratumumab for transplant-ineligible newly diagnosed multiple myeloma in China
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: Expanding treatment options for transplant-ineligible newly diagnosed multiple myeloma (ndMM) in China has increased the need to identify treatment strategies that improve patient outcomes while using healthcare resources efficiently. This study evaluated the cost-effectiveness of in-class transition (iCT) to ixazomib, lenalidomide and dexamethasone (IRd) versus daratumumab, lenalidomide and dexamethasone (DRd) for transplant-ineligible ndMM from the perspective of the Chinese healthcare system. Materials & methods: A cost-effectiveness analysis was conducted using a Markov cohort model that simulated lifetime health benefits and medical costs for the two treatment modalities. Model inputs were estimated from best available real-world evidence in the literature and from public data sources. Deterministic, probabilistic and scenario sensitivity analyses were performed to assess uncertainty in model results. Results: In the base-case analysis, iCT IRd was projected to generate 0.580 additional quality-adjusted life years versus DRd (4.724 vs 4.144) and save lifetime medical costs by $7751. One-way sensitivity analysis indicated that cost-effectiveness was driven by uncertainty in model inputs related to treatment discontinuation and subsequent disease progression. Probabilistic sensitivity analysis estimated that iCT IRd had 79.2%, 88.0% and 91.3% probabilities of being cost-effective at willingness-to-pay thresholds of one, two and three-times China’s 2025 gross domestic product per capita per quality-adjusted life year, respectively. Conclusion: Based on best available real-world evidence, the iCT IRd modality could be cost-effective compared with the DRd modality for transplant-ineligible patients with ndMM in China. Future real-world studies are needed to confirm the projected outcomes.
Plain language summary: Comparing the value of an ixazomib-based sequential strategy with antibody-based treatment for newly diagnosed myeloma in China
What is this article about?
Multiple myeloma is an incurable blood cancer. For newly diagnosed patients in China who are not eligible for stem cell transplant, selecting an initial treatment strategy is clinically important and can also affect long-term health outcomes and medical costs. This study used a computer model to simulate lifetime health outcomes and medical costs under the two treatment strategies (started with bortezomib-based induction therapy and followed by maintenance treatment containing oral ixazomib [iCT IRD] versus using daratumumab [DRd] as induction and maintenance treatment) that could be used in real-world clinical practices.
What were the results?
The model projected that iCT IRd could provide more quality-adjusted survival while reducing total medical expenditures over a patient’s lifetime compared with DRd. These projected differences were driven mainly by treatment discontinuation, the risk of disease progression after discontinuation and the later-line treatments.
Why is this important?
This study suggests that for newly diagnosed multiple myeloma patients in China who cannot undergo a stem cell transplant, the iCT IRd strategy could offer a practical alternative to DRd by extending quality-adjusted life expectancy while reducing overall medical costs. These findings provide initial economic evidence that may help health system planners and policymakers evaluate treatment access, though because these conclusions rely on computer modeling and assumptions, future real-world clinical studies will be essential to confirm whether these projected health and cost benefits hold true in actual practice.
Supplementary Material
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Received: 3 July 2026
Accepted: 28 August 2026
Published online: 13 October 2026
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Real-world cost-effectiveness of sequential therapy of in-class transition to ixazomib versus daratumumab for transplant-ineligible newly diagnosed multiple myeloma in China. (2026) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2026-0146
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