Utilization of Momelotinib for Myelofibrosis With Anemia Can Result in Small Savings

Although momelotinib to treat myelofibrosis (MF) with anemia has a higher acquisition cost, it is partially offset by savings when transfusion-related costs are reduced, according to a poster being presented at the AMCP Annual Conference, held April 15-18, 2024, in New Orleans, Louisiana.¹

MF is a rare cancer in the bone marrow that disrupts the production of blood cells.² MF causes anemia because of the extensive scarring to bone marrow. This extensive scarring also causes patients to have a low number of platelets, increasing their risk of bleeding. Patients may also have an enlarged spleen.

Momelotinib inhibits Janus kinase (JAK) 1, JAK2, and activin A receptor type 1. In September 2023, the FDA approved momelotinib to treat patients with intermediate- or high-risk MF with anemia.³

The approval of momelotinib was based on data from the phase 3 MOMENTUM trial, which found clinically significant improvements for patients treated with momelotinib vs danazol.⁴ A quarter of patients treated with momelotinib had a 50% or greater reduction in total symptom score compared with only 16% of patients on danazol.

Since the approval, the National Comprehensive Cancer Network (NCCN) has added momelotinib⁵ to its Clinical Practice Guidelines in Oncology for Myeloproliferative Neoplasms. Momelotinib was added as a category 2A treatment for patients with high-risk MF. It was also added as a 2B category treatment for patients with lower-risk MF.

Patients with MF who have anemia and are dependent on transfusions have increased medical costs and poor prognosis, the authors of the AMCP poster noted. JAK inhibitors may provide improvements in symptoms and spleen size, but they could worsen or induce anemia. However, momelotinib has been shown to reduce spleen size.⁴

The introduction of momelotinib to treat myelofibrosis with anemia can result in small savings due to reduced transfusion-related costs, according to a budget impact model.

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The authors created a budget impact model using US commercial and Medicare perspectives to estimate the 3-year projected budget impact of momelotinib entering the market to treat patients with intermediate- or high-risk MF with anemia.¹ The model estimated the impact of momelotinib for patients either with or without previous JAK inhibitor treatment. The researchers calculated the difference between total costs associated with the current market of ruxolitinib, fedratinib, pacritinib, and other therapies, and the proposed market with momelotinib.

The model included 1 million patients from combined commercial and Medicare plans. Over 3 years, the estimated average budget impact was a total of $314,222, which came out to $644.73 per patient treated with momelotinib and $0.026 per member per month. Acquisition costs of momelotinib and ruxolitinib and the proportion of patients with anemia who had previous treatment with JAK inhibitors had the largest impact on the budget.

According to the budget impact model, momelotinib created savings in transfusion status–related disease management costs, which decreased by an average of $113,694 per year over 3 years. Momelotinib also resulted in 119 fewer transfusions over 3 years.

Overall, momelotinib had a small positive budget impact over 3 years after its introduction; however, the impact of it was further decreased in scenarios with higher utilization of ruxolitinib plus luspatercept.

References

1. Purser M, Liu T, Gorsh B, et al. Estimating the financial impact of introducing momelotinib as a treatment option for adult patients with intermediate- or high-risk myelofibrosis with anemia from a US commercial and Medicare payer perspective. Presented at: AMCP; April 15-18, 2024; New Orleans, LA. Abstract D16.

2. Myelofibrosis. Mayo Clinic. December 28, 2022. Accessed April 11, 2024. https://www.mayoclinic.org/diseases-conditions/myelofibrosis/symptoms-causes/syc-20355057

3. McNulty R. FDA approves momelotinib for myelofibrosis with anemia. The American Journal of Managed Care^® website. September 15, 2023. Accessed April 11, 2024. https://www.ajmc.com/view/fda-approves-momelotinib-for-myelofibrosis-with-anemia

4. Verstovsek S, Gerds AT, Vannucchi AM, et al; MOMENTUM study investigators. Momelotinib versus danazol in symptomatic patients with anaemia and myelofibrosis (MOMENTUM): results from an international, double-blind, randomised, controlled, phase 3 study. Lancet. 2023;401(10373):269-280. doi:10.1016/S0140-6736(22)02036-0

5. Steinzor P. NCCN guidelines update adds momelotinib below ruxolitinib for high-, low-risk myelofibrosis. The American Journal of Managed Care website. January 23, 2024. Accessed April 11, 2024. https://www.ajmc.com/view/nccn-guidelines-update-adds-momelotinib-below-ruxolitinib-for-high--low-risk-myelofibrosis