Primary Risk Drivers
Below is a snapshot of domains that materially influence the MARA Rating.
Clinical effectiveness
Daratumumab in combination shows moderate benefit over standard care, with evidence indicating improved haematological response rates (53% vs 18% in the interim analysis) and longer times to major organ deterioration. However, overall survival data remains immature and has not demonstrated a statistically significant improvement compared to standard care.
Cost effectiveness
The cost-effectiveness estimates for daratumumab are within the acceptable range for Healthcare resources, with the committee concluding that the ICERs presented were reasonable given the context of the treatment’s benefits and the rarity of the condition.
Quality of life
The treatment is expected to improve quality of life by delaying major organ deterioration and potentially improving survival, although specific HRQoL data from the ANDROMEDA trial are not fully validated. The committee acknowledged the importance of haematological response in improving overall well-being.
Supporting Domains
Safety and Adverse Effects
Daratumumab has a tolerable safety profile, with adverse events occurring at similar frequencies to standard care. The committee noted that the trial excluded patients with advanced disease who might experience more severe adverse effects, but overall, the adverse events were manageable.
Comparator Selection
The treatment was compared against the appropriate standard of care (bortezomib plus cyclophosphamide and dexamethasone), which is relevant for the patient population. The committee agreed that this was the relevant comparator for the appraisal.
Patient Population and Subgroups
The trial population is broadly representative of the Healthcare population likely to receive daratumumab, although it excluded patients with severe complications. The committee concluded that the population is likely generalizable to the intended patient group.
Care Pathway Integration
Daratumumab can be integrated into existing treatment pathways with minor adjustments, as it follows a similar induction and maintenance approach used in multiple myeloma treatments. The committee noted that the Healthcare could implement the stopping rule for treatment.
Resource Use and Cost Implications
The budget impact is manageable, and the treatment is expected to provide value for the resources used, particularly given the rarity of the condition and the unmet need for effective treatments.
Evidence Quality and Robustness
While the evidence from the ANDROMEDA trial is robust in terms of haematological response, the overall survival data is still immature, leading to some uncertainty in the evidence base. The committee noted the need for further data to strengthen the conclusions.
Uncertainty, Sensitivity, and Broader Impacts
There are significant uncertainties regarding the long-term survival benefits and the extrapolation of data from the ANDROMEDA trial. The committee acknowledged these uncertainties but also considered the innovative nature of the treatment and the unmet need.
