Ryan Haumschild, PharmD, MS, MBA: I want to finish off with a question for Dr Richter. I’ve been involved in clinical pathways, and we’ve used them in solid tumors, and we’ve used them in a number of areas, and it creates consistency of practice, especially in large practices where you might have a community oncology arm and different practitioners. But I’ve always been told, that’s going to be so hard to apply to multiple myeloma pathways, there’s so much variability. But we’re starting to see some best practices. You mentioned quadruplet therapy for standard-risk patients, can that be more of a pathway utilization, where we have predictability in terms of what’s going to be selected for patient by line of therapy? I’m curious, we talked about tools, Jay did a great job. But Josh, for decision support tools in the EMR [electronic medical record] and clinical pathways driving consistent decision criteria, do you think that’s going to be possible in a way that we can manage cost and create more predictable outcomes?

Joshua Richter, MD: First, let me throw out some numbers just because I don’t know if everyone listening understands when we’re talking about costs, how great some of these can be. Oral therapies range from $10,000 to $25,000 a month. The average triplet in the US [United States] is between $350,000 and $550,000 a year. Now, that’s not just direct drug costs, but all the supportive care. And in the United States, we’re coming up to around 150,000, 160,000 patients. These are people who live for many years, so 160,000 patients, upward of a half a million dollars a year for 10 years. These are some extremely large numbers. Some of the things we’re looking at in the real world, as Muhamed beautifully pointed out, and Roy said as well, we have so many drugs, there isn’t enough money in the world to fund every study up front. It’s not going to be bench to bedside. We’re going to have to use some real-world data, back to the bedside, back to the bench in the other direction to figure things out.

I was involved in some great work that was being done at a company that was trying to answer this, to say, we have 10 choices up front, 3 are the most likely utilized. Let’s compare the efficacy and toxicity, and if we can narrow down the 2 best that are equivalent in efficacy and toxicity, but you could save money in 1 of them, shouldn’t we go that direction? Myeloma, it’s so complex, I don’t know that we’re ever going to have this as your 1 choice up front, this is your 1 choice in the relapsed setting. However, if we could get together enough data from real-world evidence, from clinical trial evidence, and say, these several regimens up front are relatively equivalent, except one of them is significantly less expensive. Then we can save here and at the same time provide top quality care to everyone. It doesn’t have to be an all or none.

This transcript has been edited for clarity.