Dr Ajay Nooka Discusses Cost Savings and QOL Benefits of MRD-Directed Treatment Decisions

Being able to use minimal residual disease (MRD) negativity to make treatment decisions, such as stopping maintenance therapy, can have savings related to cost and quality of life for patients, said Ajay Nooka, MD, MPH, FACP, associate professor, Winship Cancer Institute.

Transcript

What elements of cancer care are covered in your evaluation of cost effectiveness? Do you consider drug costs only or other costs, such as infusion time?

We've looked at, what are the potential savings? If we devise an algorithm, if we devise a framework saying, “Somebody is on LEN [lenalidomide] maintenance for a 2-year-period, they achieved 2 consecutive MRD negativity values, a 10T, separated by almost a year or so, are these the right patients to stop maintenance?” So, the answer is yes. What would be the cost savings is what we looked at.

We made some assumptions. If somebody stops with sustained MRD negativity, they should have more MRD testings that are incorporated into their care every 3 months, including a bone marrow biopsy, including the patient visiting every 3 months, and so on. Whereas the control patient population, what we normally do: these patients don't go through those repeat, sequential MRD testing to look for that MRD negativity. What we do in this patient population is to continue giving them the standard of care of LEN maintenance, until progression. Using these 2 frameworks—the framework that I described about the discontinuation of the treatment—and comparing the cost savings over time is what we looked at.

It is clearly showing that in the long run, there's a huge significant savings, both from the cost and from the quality-of-life perspective, and a significant savings advantage if you're able to find that right recipe to identify those patients who would be able to stop off maintenance, because continuing the treatment comes with its baggage. It comes with adverse events; it comes with the declining quality of life. Those all could be prevented by doing this.