Real-world health care costs of relapsed/refractory multiple myeloma during the era of novel cancer agents

Abstract

Real-world costs during treatment of relapsed/refractory multiple myeloma vary greatly. Cost drivers include hospital admissions and acquisition costs of novel agents. Costs also vary by prognostic factors and treatment-related resource use. Future studies assessing the costs of combination therapy consisting of two or more novel agents are encouraged.

Patterns of total cost and economic consequences of progression for patients with newly diagnosed multiple myeloma

“…To our knowledge, the current analysis is the first to use real-world data to document and compare cost patterns specifically in patients with NDMM and patients with relapsed MM treated with LEN-or BORT-containing regimens, accounting for the full time period from therapy initiation through next therapy. Our findings are consistent with a recent retrospective study of direct costs among patients with relapsed MM in the Netherlands, where the authors used similar monthly cost analysis techniques and found lower monthly costs in earlier lines of therapy and in patients with relapsed MM receiving LEN-based regimens compared with those receiving BORT-based regimens 13 . In contrast, Teitelbaum et al 17 conducted a US claimsbased retrospective study to evaluate and compare the healthcare costs of three novel agents (LEN, BORT, and thalidomide) against other standard MM treatment options and reported that LEN was associated with the highest total costs, although this analysis was limited to a follow-up period of 1 year after treatment initiation.…”

“…Consistent with methods described by Gaultney et al 13 , monthly total costs were calculated by summing total direct costs incurred by all patients in each successive month and dividing by the sum of patient-months; the costs were then stratified by components of care. In addition, to provide a clearer basis for evaluating temporal trends, quarterly cost patterns of monthly costs for each line of therapy were evaluated by summing total costs and dividing by the sum of patient-months within each quarter.…”

“…Although several economic studies have analyzed the real-world healthcare costs associated with BORT and LEN, they have been conducted almost exclusively in the context of relapsed/refractory MM and mostly in populations outside of the United States 13,[16][17][18][19][20] . To our knowledge, the current analysis is the first to use real-world data to document and compare cost patterns specifically in patients with NDMM and patients with relapsed MM treated with LEN-or BORT-containing regimens, accounting for the full time period from therapy initiation through next therapy.…”

“…However, the Charlson Comorbidity Index scores and multiple regression analysis suggests similar populations and that there is no substantial selection bias between the groups, based on data available from claims. Costs were evaluated through the end of the first and second lines of therapy but not through the end of the third or subsequent lines; it is not known whether subsequent cost patterns would vary between treatment cohorts and produce different overall results (although the work of Gaultney et al 13 suggests they may not). Whether the savings resulting from longer TTNT would be offset by the potential for higher cumulative lifetime costs if patients live longer remains unknown.…”

“…A recent retrospective chart review in the Netherlands showed that patients with relapsed myeloma incurred higher monthly costs upon advancing to later lines of therapy 13 . However, few published studies have examined the cost patterns of patients with MM before and after the first relapse, using real-world cost data.…”