Pcn158 Patient Burden and Costs for the Treatment of Multiple Myeloma in Finland in 2009-2016, Using Multiple Data Sources: An Electronic Hospital Database, Medical Chart Review, and Interviews With Healthcare Professionals

Abstract

for therapeutic regimen derived from GALLIUM and PRIMA clinical trials: in particular, progression-free survival (PFS), early progressive disease (PD), and treatment duration (TTOT) were extrapolated by fitting parametric distributions on empirical data in GALLIUM, whilst late PD on data in PRIMA, due to immature data in GALLIUM. PD state was split in early (progression within 2-years) and late since patients progressing early have much poorer survival outcomes than those progressing later. Expected survival was weighted by published utilities. Unit costs were collected from official and published Italian sources. Costs, updated to 2018 Euro, and health gains occurring after the first year were discounted at an annual 3% rate. Sensitivity and scenario analyses were carried out, with the aim of evaluating uncertainty around model assumptions. Results: Obinutuzumab is associated with incremental survival (1.3 LYs), even when weighted for quality (1.1 QALYs), and incremental costs (V 24,000), driven by longer treatment duration in the progression-free state relative to rituximab. Incremental ratios (around V 18,000 per LY and V 21,500 per QALY gained) are widely within the range considered acceptable by the Italian NHS. 1,000 PSA simulations confirm robustness of results to sensible variations in assumptions. Conclusions: Obinutuzumab has a superior clinical efficacy, as compared to rituximab, and should be considered a cost-effective option in the first line treatment of advanced FL in Italy: incremental cost-effectiveness ratios are below the threshold considered sustainable by developed countries.

Characterizing the Patient Journey in Multiple Myeloma: Qualitative Review

“…In some European countries and the United States, the treatments received by patients for MM and other comorbidities have a substantial impact on costs, which can often be greater than the patients' ability to pay. The often-unmet financial needs of patients with MM can moderate the relationship between psychological morbidity and HRQOL [32,35,36]. In the United States, a study of 160 patients with RRMM found that treatment copays and the costs associated with visits to the clinic contributed the greatest burden to overall costs [32].…”

“…A Portuguese cross-sectional study (N=124) found that 91.9% of previously treated patients with MM reported an unmet financial need, and when financial needs were higher, there was a negative relationship between psychological morbidity and HRQOL [35]. In Finland, an observational study assessed MM-related health care resource use and costs in patients with "active" MM (N=97) treated between 2009 and 2016 [36]. An average travel distance of 35.4 km (approximately 22 miles) was reported for health care visits, which placed a substantial financial burden on patients as the mean per-patient travel costs per 28 days ranged from €75.13 (US $76.42) to €447.99 (US $455.68) [36].…”

“…In Finland, an observational study assessed MM-related health care resource use and costs in patients with "active" MM (N=97) treated between 2009 and 2016 [36]. An average travel distance of 35.4 km (approximately 22 miles) was reported for health care visits, which placed a substantial financial burden on patients as the mean per-patient travel costs per 28 days ranged from €75.13 (US $76.42) to €447.99 (US $455.68) [36]. No patient-reported information on the cost of MM to the patient was discussed.…”

“…Both the literature and patient-reported information reported that symptoms and treatment side effects affect areas of HRQOL, including physical functioning; emotional, psychological, and social well-being; the ability to work; and relationships [9]. Furthermore, patients reported economic impacts, and almost all patients reported some form of unmet financial need [32,35,36].…”