Socioeconomic Factors and Survival of Multiple Myeloma Patients

Abstract

Background: Outcome of Multiple Myeloma (MM) patients has improved as the result of the introduction of novel medications and use of autologous hematopoietic cell transplantation. However, this improvement comes at the expense of increased financial burden. It is largely unknown if socioeconomic factors influence MM survival. Methods: We used the National Cancer Database, a database that houses data on 70% of cancer patients in the US, to evaluate the effect of socioeconomic factors on the survival of 117,926 MM patients diagnosed between 2005 and 2014. Results: Patients aged ≥65 years who were privately insured lived longer than patients with Medicare (42 months vs. 31 months, respectively, p < 0.0001). Treatment in academic institutions led to better survival (HR: 1.49, 95% CI: 1.39, 1.59). Younger age, fewer comorbidities, treatment in academic centers, and living in a higher median income area were significantly associated with improved survival. After adjusting for confounders, survival of Medicare patients was similar to those with private insurance. However, the hazard of death remained higher for patients with Medicaid (HR: 1.59, 95% CI: 1.36, 1.87) or without insurance (HR: 1.62, 95% CI: 1.32, 1.99), compared to privately insured patients. Conclusion: Economic factors and treatment facility type play an important role in the survival of MM patients.

Autologous stem cell transplantation in an older adult population

“…Analysis of National Cancer Database (NCDB) showed that ASCT improved survival for MM patients from all economic backgrounds, but uninsured patients or those with Medicaid had significantly lower overall survival. 19 Similar trends have been observed with in patients with NHL. 20 …”

“…Analysis of National Cancer Database (NCDB) showed that ASCT improved survival for MM patients from all economic backgrounds, but uninsured patients or those with Medicaid had significantly lower overall survival. 19 Similar trends have been observed with in patients with NHL. 20 This study has limitations such as retrospective design, small sample size, variability in minority proportion, and melphalan dosing discrepancy between the groups.…”

Lack of a caregiver is associated with shorter survival in myeloma patients undergoing autologous stem cell transplantation

“…Those with lower socioeconomic status often have multiple challenges to consistent access to care and associated with worse outcomes in patient with myeloma. [4] The lack of a statistically signi cant difference on multi variable analysis may be related to the small number of patients that required inpatient transplantation making the statistics under powered for detecting a difference that may be present with a larger cohort for analysis. A second possibility for the lack of statistical signi cance is the powerful impact of stage on outcome in myeloma which may overwhelm other potentially important variables that could only be demonstrated in a much larger cohort.…”

Idecabtagene vicleucel: questions regarding the appropriate role and cost

“…4 Not only is the cost high, but the budgetary impact may be massive given the large number of eligible multiple myeloma patients who are on Medicare. 5 Whether and to what degree the cost of ide-cel is sustainable for a therapy that will only delay inevitable progression is a matter of debate. That said, the budgetary impact and emerging insurance conflict pose the question, how willing is society to pay for a toxic therapy that patients will eventually progress on?…”

“…While other CAR‐T therapies are similarly priced, this is the first approved CAR‐T that, despite impressive objective responses and induced remissions in even refractory cases, is non‐curative 4 . Not only is the cost high, but the budgetary impact may be massive given the large number of eligible multiple myeloma patients who are on Medicare 5 . Whether and to what degree the cost of ide‐cel is sustainable for a therapy that will only delay inevitable progression is a matter of debate.…”