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Gasoyan H, Anwer F, Casacchia NJ, Kovach JD, Valent J, Wang M, Halpern MT, Rothberg MB. Role of Patient Characteristics and Insurance Type in Newly Diagnosed Multiple Myeloma Care Disparities. JCO Oncol Pract 2024; 20:699-707. [PMID: 38354331 DOI: 10.1200/op.23.00672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/12/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Little is known about the role of social determinants of health (SDOH) in the utilization of novel treatments among patients with newly diagnosed multiple myeloma (NDMM). METHODS This retrospective cohort study used Taussig Cancer Center's Myeloma Patient Registry to identify adults with NDMM between January 1, 2017, and December 31, 2021. Electronic health records data captured treatment with (1) triplet or quadruplet regimen and (2) lenalidomide during the first year after NDMM, and (3) stem-cell transplant (SCT) through December 31, 2022. Multivariable logistic regression models examined associations of demographic/clinical characteristics and SDOH with care patterns. RESULTS We identified 569 patients with median age at diagnosis of 66 years (IQR, 59-73); 55% were male, 76% White, 23% Black, 1.1% other races, insured by Medicare (51%), private payer (38%), Medicaid (8.3%), and self-pay/other (1.8%). In the multivariable models, self-pay/other payers (adjusted odds ratio [AOR], 0.15 [95% CI, 0.03 to 0.54]) was associated with lower odds of triplet or quadruplet regimen, compared with Medicare. Private insurance (AOR, 0.48 [95% CI, 0.27 to 0.86]) and self-pay/other payers (AOR, 0.16 [95% CI, 0.04 to 0.74]) had lower odds of lenalidomide. Black patients (v White; AOR, 0.47 [95% CI, 0.26 to 0.85]) and patients treated at regional hospitals (v Taussig Cancer Center; AOR, 0.27 [95% CI, 0.12 to 0.57]) had lower odds of SCT. The odds of receiving triplet or quadruplet regimen, lenalidomide, and SCT also varied by the year of NDMM. CONCLUSION Care for NDMM varied based on race, insurance type, year of diagnosis, and treatment facility. It may be useful to examine the impact of insurance-related characteristics and recent policy initiatives on care disparities.
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Affiliation(s)
- Hamlet Gasoyan
- Department of Internal Medicine and Geriatrics, Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Faiz Anwer
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Nicholas J Casacchia
- Department of Internal Medicine and Geriatrics, Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, OH
| | - Jeffrey D Kovach
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Jason Valent
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD
| | - Michael B Rothberg
- Department of Internal Medicine and Geriatrics, Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Gasoyan H, Fiala MA, Doering M, Vij R, Halpern M, Colditz GA. Disparities in Multiple Myeloma Treatment Patterns in the United States: A Systematic Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e420-e427. [PMID: 37659966 PMCID: PMC10844924 DOI: 10.1016/j.clml.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/09/2023] [Indexed: 09/04/2023]
Abstract
We performed a systematic review of the literature investigating the demographic and insurance-related factors linked to disparities in multiple myeloma (MM) care patterns in the United States from 2003 to 2021. Forty-six observational studies were included. Disparities in MM care patterns were reported based on patient race in 76% of studies (34 out of 45 that captured race as a study variable), ethnicity in 60% (12 out of 20), insurance in 77% (17 out of 22), and distance from treating facility, urbanicity, or geographic region in 62% (13 out of 21). A smaller proportion of studies identified disparities in MM care patterns based on other socioeconomic characteristics, with 36% (9 out of 25) identifying disparities based on income estimate or employment status and 43% (6 out of 14) based on language barrier or education-related factors. Sociodemographic characteristics are frequently associated with disparities in care for individuals diagnosed with MM. There is a need for further research regarding modifiable determinants to accessing care such as insurance plan design, patient out-of-pocket costs, preauthorization criteria, as well as social determinants of health. This information can be used to develop actionable strategies for reducing MM health disparities and enhancing timely and high-quality MM care.
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Affiliation(s)
- Hamlet Gasoyan
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, OH.
| | - Mark A Fiala
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michelle Doering
- Bernard Becker Medical Library, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ravi Vij
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
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3
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Yang J, Boytsov N, Carlson JJ, Barthold D. Health care resource utilization and costs among patients with multiple myeloma with exposure to double-class or triple-class multiple myeloma treatments: A retrospective US claims database analysis. J Manag Care Spec Pharm 2023; 29:917-926. [PMID: 37523320 PMCID: PMC10397331 DOI: 10.18553/jmcp.2023.29.8.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND: Despite recent advancements in the therapeutic landscape, multiple myeloma (MM) remains incurable. There are multiple treatment options available with a novel mechanism of action, but there is limited evidence describing the economic burden among patients with MM exposed to different drug classes and combinations and across different health care settings. OBJECTIVE: To describe all-cause and MM-related health care resource utilization (HCRU) and costs among patients with MM exposed to different drug classes and combinations (ie, double-class and triple-class-exposed) and characterize the economic burden in different health care settings among these patients with MM. METHODS: We conducted a retrospective cohort study using the IBM MarketScan databases. The study included adult patients (aged ≥18 years) diagnosed with MM between December 1, 2015, and December 31, 2019. The study sample comprised double-class-exposed (DCE) and triple-class-exposed (TCE) cohorts, categorized based on their earliest exposure to different combinations of immunomodulatory drugs, proteasome inhibitors, or targeted monoclonal antibody. Patients with at least 1 subsequent line of therapy following the categorization were included, and the start date of the first subsequent line of therapy was the index date. The primary outcomes were all-cause and MM-related HCRU and costs during the follow-up period. Costs were stratified across 8 care settings defined by place of service. The Kaplan-Meier sample average technique was used to estimate the cumulative mean outcomes, accounting for differential follow-up periods. The outcomes were reported as per patient per month (PPPM). 18 years) diagnosed with MM between December 1, 2015, and December 31, 2019. The study sample comprised double-class-exposed (DCE) and triple-class-exposed (TCE) cohorts, categorized based on their earliest exposure to different combinations of immunomodulatory drugs, proteasome inhibitors, or targeted monoclonal antibody. Patients with at least 1 subsequent line of therapy following the categorization were included, and the start date of the first subsequent line of therapy was the index date. The primary outcomes were all-cause and MM-related HCRU and costs during the follow-up period. Costs were stratified across 8 care settings defined by place of service. The Kaplan-Meier sample average technique was used to estimate the cumulative mean outcomes, accounting for differential follow-up periods. The outcomes were reported as per patient per month (PPPM). RESULTS: The study included 1,521 patients with MM, of whom 1,016 (66.8%) were DCE and 505 (33.2%) were TCE. The mean total all-cause health care costs were $20,338 PPPM, and approximately 85% of the total all-cause costs were MM-related. The mean all-cause and MM-related total costs were driven by overall drug costs primarily attributed to MM treatment and administration costs. The TCE cohort was associated with more HCRU and incurred higher costs than the DCE cohort across all categories. The hospital-based ambulatory setting had the highest all-cause and MM-related costs during the follow-up period: $7,302 (95% CI = $6,801-$7,784) PPPM and $6,695 (95% CI = $6,239-$7,136) PPPM, respectively. CONCLUSIONS: The study findings suggest that the economic burden following exposure to multiple drug classes and combinations is substantial, especially among the TCE cohort and in the ambulatory setting. These findings highlight the need for more effective treatments that can mitigate the economic burden of patients with MM. Future research on the HCRU and costs related to recently approved MM treatments with novel mechanisms is warranted. DISCLOSURES: At the time of this study, Dr Yang was a postdoctoral fellow and the fellowship was supported by GSK. Dr Boytsov is a full-time employee of GSK. Dr Carlson discloses consulting fees from Pfizer, AbbVie, and Genentech. Dr Barthold reports no disclosures.
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Affiliation(s)
- Joseph Yang
- Department of Pharmacy, CHOICE Institute, University of Washington, Seattle
| | | | - Josh J Carlson
- Department of Pharmacy, CHOICE Institute, University of Washington, Seattle
| | - Douglas Barthold
- Department of Pharmacy, CHOICE Institute, University of Washington, Seattle
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4
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Bennink C, de Mul M, van der Klift M, Broijl A, Tick L, de Jongh E, Garvelink M, Lobbezoo D, Sonneveld P, Hazelzet J. Improving Outcome-Driven Care in Multiple Myeloma Using Patient-Reported Outcomes: A Qualitative Evaluation Study. THE PATIENT 2023; 16:255-264. [PMID: 36790557 PMCID: PMC9930010 DOI: 10.1007/s40271-023-00616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Multiple myeloma is an incurable disease with a considerable illness and treatment burden, which negatively impacts patients' quality of life. This study aimed to evaluate the implementation of multiple myeloma care in five Dutch hospitals, related to the three objectives of outcome-driven care, which are defined as (1) providing information for shared decision making in individual patient care, (2) supporting the learning capacity of healthcare professionals and healthcare institutions through benchmarking and (3) developing outcome-driven and patient-centred contracting by health insurers. METHODS In this qualitative study, semi-structured interviews about experiences with patient-reported outcomes were conducted with patients, healthcare professionals and other stakeholders 2 years after implementation. Data were thematically analysed, and emerging topics were clustered around the three objectives of outcome-driven care. RESULTS A total of 46 interviews were held (15 with patients, 16 with professionals and 15 with other stakeholders) that showed patients with multiple myeloma were willing to complete patient-reported outcomes, although integration of patient-reported outcomes in shared decision making fell short in clinical practice. Aggregated patient-reported outcomes were considered important for improving quality of care; however, data collection and data exchange are hindered by privacy legislation, limitations of IT systems and a lack of data standards. Patient-reported outcomes were expected to contribute to cost-effective multiple myeloma treatment, yet outcome-driven reimbursement is still lacking. CONCLUSIONS Outcome-driven multiple myeloma care using patient-reported outcomes is feasible, provided that (1) patient-reported outcomes and shared decision making are integrated into clinical practice, (2) legal and technical obstacles hindering data collection are removed and (3) health insurers adjust their reimbursement plans to facilitate outcome-driven care.
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Affiliation(s)
- Christine Bennink
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Department of Haematology, Amphia, Breda, The Netherlands.
| | - Marleen de Mul
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | | | - Annemiek Broijl
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Lidwine Tick
- Department of Haematology, Maxima Medical Center, Veldhoven, Eindhoven, The Netherlands
| | - Eva de Jongh
- Department of Haematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mirjam Garvelink
- Department of Haematology, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Dorien Lobbezoo
- Department of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pieter Sonneveld
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jan Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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5
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Measuring hospital-related burden of treatment in multiple myeloma using Electronic Health Records’-reimbursement data. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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6
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Mohyuddin GR, Sinnarajah A, Gayowsky A, Chan KKW, Seow H, Mian H. Quality of end-of-life care in multiple myeloma: A 13-year analysis of a population-based cohort in Ontario, Canada. Br J Haematol 2022; 199:688-695. [PMID: 35949180 DOI: 10.1111/bjh.18401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
Optimizing end-of-life (EOL) care for multiple myeloma (MM) represents an unmet need. An administrative cohort in Ontario, Canada was analysed between 2006 and 2018. Aggressive care was defined as two or more emergency-department visits in the last 30 days before death, or at least two new hospitalizations within 30 days of death, or an intensive care unit (ICU) admission within the last 30 days of life. Supportive care was defined as a physician house-call in the last two weeks before death, or a palliative nursing or personal support visit at home in the last 30 days before death. Among 5095 patients, 23.2% of patients received chemotherapy at EOL and 55.6% of patients died as inpatient. A minority received aggressive care at EOL [28.3%: autologous stem cell transplant (ASCT), 20.4%: non-ASCT], and a majority received supportive care at EOL (65.4%: ASCT, 61.5%: non-ASCT). Supportive care was less likely to be received by those aged over 80 years and in lower-income neighbourhoods. Supportive care at EOL increased from 56.0% in 2006 to 70.3% in 2018. Despite improvements, many patients with MM experience aggressive care at EOL. Even in a publicly funded health care system, disparities based on age, income and community size are present.
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Affiliation(s)
| | | | | | - Kelvin K W Chan
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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7
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Borgsten F, Gatopoulou X, Pisini M, Tambour M, Schain F, Jones CV, Kwok KHM, Batyrbekova N, Björkholm M. Healthcare resource utilisation and sickness absence in newly diagnosed multiple myeloma patients who did not undergo autologous stem cell transplantation: Trends in Sweden with the changing treatment landscape. Eur J Haematol 2021; 107:92-103. [PMID: 33728732 DOI: 10.1111/ejh.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The introduction of novel drugs has significantly improved outcomes for multiple myeloma (MM) patients. This study describes survival, healthcare resource utilisation and sickness absence in association with the changing MM treatment landscape over time, focussing on patients who did not undergo autologous stem cell transplantation (ASCT). METHODS Population-based, retrospective registry study in Sweden, where 7012 non-ASCT patients diagnosed between 2001 and 2015 were stratified into diagnosis periods 2001-2005 (n = 2053), 2006-2010 (n = 2372) and 2011-2015 (n = 2587). RESULTS Median survival increased from 2.5 to 3.4 years from 2001-2005 to 2011-2015. During the first 3 years of follow-up, patients diagnosed during 2011-2015 spent 29% and 12% less time in health care (55 days; inpatient admissions and outpatient visits) than patients diagnosed during 2001-2005 (78 days) and 2006-2010 (63 days), respectively. This was associated with less inpatient and more outpatient healthcare usage. Average 3-year sickness absence (362 days) was 31% and 12% less than for patients diagnosed during 2001-2005 (522 days) and 2006-2010 (410 days), respectively. CONCLUSIONS These findings of improved survival, reduced healthcare needs and greater productivity in non-ASCT MM patients with access to improved treatment practices and novel drugs provide important real-world cost-benefit insights for the continued development and introduction of treatments for MM.
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Affiliation(s)
| | | | | | | | - Frida Schain
- Schain Research AB, Bromma, Sweden.,Division of Hematology, Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Christina V Jones
- Schain Research AB, Bromma, Sweden.,Department of Cell and Molecular Biology, Karolinska Institutet, Solna, Sweden
| | - Kelvin Ho Man Kwok
- Schain Research AB, Bromma, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Nurgul Batyrbekova
- SDS Life Science, Danderyd, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Magnus Björkholm
- Division of Hematology, Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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Fonseca R, Hagiwara M, Panjabi S, Yucel E, Buchanan J, Delea T. Economic burden of disease progression among multiple myeloma patients who have received transplant and at least one line of therapy in the US. Blood Cancer J 2021; 11:35. [PMID: 33941766 PMCID: PMC8093246 DOI: 10.1038/s41408-021-00431-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 01/15/2023] Open
Abstract
Effects of disease progression on healthcare resource utilization (HRU) and costs among multiple myeloma (MM) patients with ≥1 line of therapy (LOT) who received their first stem cell transplant (SCT) within 1 year of initial MM diagnosis were estimated using a large US claims database. Disease progression was defined as advancement to the next LOT, bone metastasis, hypercalcemia, soft tissue plasmacytoma, skeletal related events, acute kidney disease, or death within 12 months of LOT initiation. Annual HRU and costs in the first three LOTs (L1-L3) were compared for patients with versus without disease progression using inverse probability of treatment weighting to adjust for differences between groups in baseline characteristics. In all LOTs, mean annual hospitalizations and healthcare costs were greater for patients with versus without progression. Total incremental annual costs among patients with versus without progression in L1-L3 were $18,359, $87,055, and $71,917, respectively, among LOTs initiated between 2006 and 2018. In LOTs initiated between 2013 and 2018, the figures were $46,024, $100,329, and $101,942 in L1-L3, respectively. The economic burden of disease progression is substantial in this population of MM patients who underwent SCT and received systemic anti-myeloma therapy.
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Affiliation(s)
- Rafael Fonseca
- Mayo Clinic Comprehensive Cancer Center, Phoenix, AZ, USA
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9
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Madduri D, Hagiwara M, Parikh K, Pelletier C, Delea TE, Kee A, Chari A. Real-world treatment patterns, healthcare use and costs in triple-class exposed relapsed and refractory multiple myeloma patients in the USA. Future Oncol 2021; 17:503-515. [PMID: 33522834 DOI: 10.2217/fon-2020-1003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: To estimate treatment patterns and healthcare costs among triple-class exposed relapsed and refractory multiple myeloma (RRMM) patients. Materials & methods: Eligible patients had ≥1 line of therapy (LOT) each of proteasome inhibitors, immunomodulatory drugs and daratumumab in December 2015-September 2018 and received a new LOT. Results: A total of 154 patients were included with a median follow-up of 6.2 months. Median time from diagnosis to new LOT was 41.0 months. Kaplan-Meier estimate of median time to therapy discontinuation was 4.2 months. Mean per-patient, per-month MM-related costs were USD 35,657. Most frequently observed regimens were lenalidomide or pomalidomide + daratumumab (18.2%), lenalidomide or pomalidomide + proteasome inhibitors (15.6%) and lenalidomide or pomalidomide monotherapy (11.0%). Conclusion: Triple-class exposed RRMM patients receive heterogeneous treatments for a short duration with high healthcare resource utilization and costs.
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Affiliation(s)
- Deepu Madduri
- Mount Sinai School of Medicine, New York, NY 10029, USA
| | - May Hagiwara
- Policy Analysis Inc., Chestnut Hill, MA 02467, USA
| | | | | | | | - Arianna Kee
- Bristol Myers Squibb, Princeton, NJ 08540, USA
| | - Ajai Chari
- Mount Sinai School of Medicine, New York, NY 10029, USA
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10
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Mian HS, Fiala MA, Wildes TM. Burden of Treatment Among Older Adults With Newly Diagnosed Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e152-e159. [PMID: 33097433 DOI: 10.1016/j.clml.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Multiple myeloma is an incurable hematologic malignancy with significant recent treatment advances; however, the magnitude of treatment burden among patients in the first year after diagnosis has yet to be fully researched and reported. PATIENTS AND METHODS Patients with multiple myeloma newly diagnosed between 2007 and 2013 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases. Treatment burden was captured as the number of total days with a health care encounter (including acute care and outpatient visits), oncology and nononcology physician visits, and the number of new prescriptions within the first year after diagnosis. Logistic regression was used to identify factors associated with high treatment burden. RESULTS A total of 3065 patients were included in the analysis. There was a substantial burden of treatment within the first year after diagnosis (median, 77 days; interquartile range, 55-105 days), which was highest during the first 3 months. Patients with high comorbidities (adjusted odds ratio [aOR] 1.27 per 1-point increase in Charlson comorbidity index, P < .001), poor performance status (aOR 1.85, P < .001), myeloma-related end organ damage, particularly bone disease (aOR 2.28, P < .001), and those who underwent autologous stem-cell transplantation (aOR 2.41, P < .001) were more likely to have a higher treatment burden. CONCLUSION There is considerable burden of treatment in patients with newly diagnosed multiple myeloma within the first year after diagnosis, particularly within the first 3 months. Future tailored interventions aimed at optimizing this treatment burden when possible while simultaneously providing support to manage it may improve patient-centered care.
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Affiliation(s)
- Hira S Mian
- Juravinski Cancer Center, Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mark A Fiala
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Tanya M Wildes
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO.
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11
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Fiala MA, Wildes TM, Vij R. Racial Disparities in the Utilization of Novel Agents for Frontline Treatment of Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:647-651. [PMID: 32522440 DOI: 10.1016/j.clml.2020.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Treatment with novel agents has become the standard of care for newly diagnosed multiple myeloma, but members of racial and ethnic minority groups receive these agents at a lower rate than their peers. Researchers have largely attributed this finding to the higher costs of these drugs in respect to traditional chemotherapies, but data supporting this hypothesis are lacking. We compared the relative bortezomib and lenalidomide utilization in patients with newly diagnosed multiple myeloma, hypothesizing that the disparity between white and African American patients would be greater for lenalidomide as a result of its higher overall and out-of-pocket costs. METHODS We reviewed the utilization patterns of bortezomib and lenalidomide using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. RESULTS Bortezomib utilization was 31% less likely for African Americans compared to whites. There was no statistically significant difference in lenalidomide utilization when other factors were controlled. CONCLUSION Our findings do not support the hypothesis that higher respective costs are the cause of the racial disparities in novel agent utilization for myeloma treatment. We postulate that travel or logistical issues, structural barriers in the medical system, and preferences and biases among patients and providers may also be involved in the observed treatment disparities.
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Affiliation(s)
- Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St Louis, MO; School of Social Work, Saint Louis University, St Louis, MO.
| | - Tanya M Wildes
- Division of Oncology, Washington University School of Medicine, St Louis, MO
| | - Ravi Vij
- Division of Oncology, Washington University School of Medicine, St Louis, MO
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12
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Thompson JF, Teh Z, Chen Y, Gardiner J, Bednarz JM, Thompson GN, Lee C, Horvath N, Bardy P, Yeung D. A costing study of bortezomib shows equivalence of its real‐world costs to conventional treatment. Br J Haematol 2020; 189:e76-e79. [DOI: 10.1111/bjh.16484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jane F. Thompson
- Haematology Department Royal Adelaide Hospital Adelaide Australia
| | - Zoe Teh
- General Medicine Royal Adelaide Hospital Adelaide Australia
| | - Yiyang Chen
- Intern Royal Adelaide Hospital Adelaide Australia
| | | | | | | | - Cindy Lee
- Royal Adelaide Hospital Adelaide Australia
| | | | - Peter Bardy
- Haematology Department Royal Adelaide Hospital Adelaide Australia
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13
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Bankar A, Zhao H, Iqbal J, Coxford R, Cheung MC, Mozessohn L, Earle CC, Gupta V. Healthcare resource utilization in myeloproliferative neoplasms: a population-based study from Ontario, Canada. Leuk Lymphoma 2020; 61:1908-1919. [PMID: 32323602 DOI: 10.1080/10428194.2020.1749607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Health resource utilization (HRU) and associated factors of high cost are not well understood in myeloproliferative neoplasms (MPNs). In this population-based, retrospective matched-cohort study, we used administrative health databases of Ontario, Canada to measure treatment costs and HRU for patients with MPN from 2004 to 2016 and compared them to matched controls. In 7130 patients with MPN [essential thrombocythemia (ET) = 3481; polycythemia vera (PV) = 2618; myelofibrosis (MF) = 1031], the mean annualized treatment costs were $16,646 for ET (controls, $7070); $16,360 for PV (controls, $7293); and $25,863 for MF (controls, $7386). Out of the total costs, the largest expenditure was on acute hospital care (ET: 57%, PV: 57%, MF: 66%). Older age (≥65), male gender, patients not seen by a specialist, and greater comorbidity burden were independent predictors of higher costs (p < 0.05). In addition, history of venous thrombosis in patients with ET and PV was associated with significantly higher treatment costs (p < 0.05).
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Affiliation(s)
- Aniket Bankar
- The Elizabeth and Tony Comper MPN Program, Princess Margaret Cancer Centre, Toronto, Canada
| | | | | | | | - Matthew C Cheung
- IC/ES, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Craig C Earle
- IC/ES, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Vikas Gupta
- The Elizabeth and Tony Comper MPN Program, Princess Margaret Cancer Centre, Toronto, Canada
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14
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Dhakal B, Narra RK, Giri S, Szabo A, Smunt TL, Ghose S, Pathak LK, Aryal M, Hamadani M, Chhabra S, Janz S, D'Souza A, Hari PN. Association of adverse events and associated cost with efficacy for approved relapsed and/or refractory multiple myeloma regimens: A Bayesian network meta-analysis of phase 3 randomized controlled trials. Cancer 2020; 126:2791-2801. [PMID: 32154922 DOI: 10.1002/cncr.32831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Several new treatment options have been approved for relapsed and/or refractory multiple myeloma (RRMM). In this systematic review, associations of the efficacy of each approved regimen with adverse events (AEs) and the total cost per cycle were compared with a Bayesian network meta-analysis (NMA) of phase 3 randomized controlled trials (RCTs). METHODS Scopus, Cochrane, PubMed Publisher, and Web of Science were searched from January 1999 to July 2018 for phase 3 RCTs of regimens (approved by the US Food and Drug Administration) used in RRMM. The relative ranking of agents was assessed with surface under the cumulative ranking (SUCRA) probabilities. The primary efficacy, safety, and cost outcomes were progression-free survival with the regimen, grade 3 to 4 AEs, and the total cost per cycle (regimen cost plus average cost of managing AEs). RESULTS Fifteen studies including 7718 patients and evaluating 14 different regimens were identified. Daratumumab, lenalidomide, and dexamethasone were ranked highest for reducing progression (hazard ratio, 0.13; 95% credible interval, 0.09-0.19; SUCRA, 1) but carried the highest probability of total cost per cycle ($41,420; 95% Credible Interval [CrCl], $58,665-$78,041; SUCRA, 0.02). Panobinostat, bortezomib, and dexamethasone were the least effective and least safe (SUCRA, 0.24), whereas bortezomib, thalidomide, and dexamethasone emerged as least effective with the highest total cost per cycle (SUCRA, 0.33). Carfilzomib and dexamethasone emerged as the winner when this regimen was considered in terms of efficacy and safety (SUCRA, 0.61) and efficacy and total cost per cycle (SUCRA, 0.60). CONCLUSIONS The results of this NMA can provide additional guidance for the decision-making process when one is choosing the most appropriate regimen for RRMM.
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Affiliation(s)
- Binod Dhakal
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ravi K Narra
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Smith Giri
- Division of Hematology/Oncology, Yale University, New Haven, Connecticut
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy L Smunt
- Sheldon B. Lubar School of Business, University of Wisconsin Milwaukee, Milwaukee, Wisconsin
| | - Sanjoy Ghose
- Sheldon B. Lubar School of Business, University of Wisconsin Milwaukee, Milwaukee, Wisconsin
| | | | - Madan Aryal
- Division of Hematology/Oncology, Roswell Park, Buffalo, New York
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Siegfried Janz
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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15
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Dashputre AA, Gatwood KS, Gatwood J. Medication Adherence, Health Care Utilization, and Costs Among Patients Initiating Oral Oncolytics for Multiple Myeloma or Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. J Manag Care Spec Pharm 2020; 26:186-196. [PMID: 32011965 PMCID: PMC10391134 DOI: 10.18553/jmcp.2020.26.2.186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Oral oncolytic therapies have improved survival in hematologic cancers, such as chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and multiple myeloma (MM), which are now being managed like chronic conditions. However, compared with other cancers, there is a lack of studies assessing adherence, health care resource utilization, and costs in patients with these cancers. OBJECTIVE To assess factors associated with adherence to oral oncolytic therapies, health care utilization, and costs in patients with CLL/SLL or MM. METHODS A retrospective database study was conducted using the IBM MarketScan Commercial Claims and Medicare Supplement databases. Adults (aged ≥ 18 years) diagnosed with and prescribed an oral oncolytic for CLL/SLL (ibrutinib or idelalisib) or MM (thalidomide, lenalidomide, or pomalidomide) between 2013 and 2016 and with continuous eligibility 6 months before and 12 months after oral oncolytic initiation were identified. Adherence to oral oncolytics was measured using the proportion of days covered (PDC) metric. Multiple linear regression and multivariable logistic regression were used to identify adherence predictors. Count models assessed the relationship between adherence and resource utilization, and generalized linear models assessed the relationship between adherence and health care costs. RESULTS A total of 701 and 2,385 patients were identified with CLL/SLL or MM, respectively. Mean PDC (SD) for CLL/SLL and MM patients was 75.3 (22.5) and 57.6 (26.5), respectively. For CLL/SLL patients, those aged ≥ 65 years (beta [B] = -4.00) had lower medication use. Among MM patients, multiple predictors of higher medication use emerged: aged ≥ 65 years (B = 3.44), higher than average outpatient resource utilization (B = 3.53), insurance plan other than preferred provider organization (PPO; B = -2.58), previous cancer therapy (B = -2.81), higher number of concurrent unique therapeutic classes (B = -0.35), and higher comorbidity burden (B = -2.55). Patients with CLL/SLL and enrolled in plans other than a PPO were more likely to be adherent (OR = 1.41, 95% CI = 1.01-1.98), whereas patients who were aged ≥ 65 years, were residents of the southern United States, and had visited the emergency department in the baseline period were less likely to be adherent. For MM patients, those aged ≥ 65 years (OR = 1.68, 95% CI = 1.38-2.04) and with higher than average outpatient services utilization (OR = 1.24, 95% CI = 1.01-1.52) were more likely to be adherent, whereas those enrolled in plans other than a PPO, previously treated with cancer therapy, and with higher comorbidity burden were less likely to be adherent. In both cohorts, adherent patients had significantly lower odds of health care utilization and incurred lower medical costs, but higher prescription costs, following oncolytic initiation; however, total costs were not significantly lower in those adherent. CONCLUSIONS Factors were identified that influenced adherence at the patient, treatment, and health system levels. These factors can be used to identify patients requiring interventions for improving medication-taking behavior and associated health care burden. DISCLOSURES This study received no outside funding. Dashputre was recently employed by Novartis; K. Gatwood has received speaker fees from Jazz Pharmaceuticals; and J. Gatwood has received research funding from Merck & Co. and GlaxoSmithKline, unrelated to this study..
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Affiliation(s)
- Ankur A. Dashputre
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis
| | | | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Nashville
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16
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Latif A, Lateef N, Razzaq F, Kapoor V, Ahsan MJ, Ashfaq M, Iftikhar A, Anwer F, Holmberg M, William P. Fundamentals of Light Chain Cardiac Amyloidosis: A Focused Review. Cardiovasc Hematol Disord Drug Targets 2020; 20:274-283. [PMID: 33256586 DOI: 10.2174/1871529x20666201130110036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 06/12/2023]
Abstract
The estimated prevalence of AL CA in the US is approximately 8-12 cases per million. Almost 30-50% diagnosed cases of AL amyloid in the US have multisystem involvement, including cardiac involvement. Even with the availability of advanced diagnostic testing and novel therapies, prognosis remains poor. It is overlooked as a cause of heart failure with preserved ejection fraction leading to a delay in diagnosis when management options are limited and associated with poor survival outcomes. Therefore, the education of physicians is needed to ensure that it would be highly considered as a differential diagnosis. The purpose of this manuscript is to review the advances in the diagnosis and management of cardiac amyloidosis with the aim of educating colleagues who provide care in the primary care setting. We have summarized the pathogenesis of amyloidosis, its association with plasma cell dyscrasias, novel diagnostic and surveillance approaches including echocardiography, cardiovascular magnetic resonance imaging, histopathologic techniques, systemic biomarkers, and advanced treatment approaches including supportive symptomatic management and standard of care chemotherapy targeting the amyloid deposits. Given the overall poor prognosis of amyloidosis, we have also discussed the role of palliative and hospice care.
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Affiliation(s)
- Azka Latif
- Creighton University Medical Center, Omaha, Nebraska, NE, 68178, United States
| | - Noman Lateef
- Creighton University Medical Center, Omaha, Nebraska, NE, 68178, United States
| | - Faryal Razzaq
- Foundation University Medical College, Islamabad, Pakistan
| | - Vikas Kapoor
- Creighton University Medical Center, Omaha, Nebraska, NE, 68178, United States
| | - Muhammad J Ahsan
- Creighton University Medical Center, Omaha, Nebraska, NE, 68178, United States
| | - Muhammad Ashfaq
- Creighton University Medical Center, Omaha, Nebraska, NE, 68178, United States
| | - Ahmad Iftikhar
- University of Arizona, Tucson, Arizona, AZ 85721, United States
| | - Faiz Anwer
- Cleveland Clinic, Cleveland, OH, United States
| | - Mark Holmberg
- Creighton University Medical Center, Omaha, Nebraska, NE, 68178, United States
| | - Preethi William
- University of Arizona, Tucson, Arizona, AZ 85721, United States
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17
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Xu T, Yang W, Chen L, Gao G. What are the implications of cost for myeloma therapy? Expert Rev Hematol 2019; 12:1005-1009. [PMID: 31625767 DOI: 10.1080/17474086.2019.1682545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Tianqi Xu
- Department of Haematology, People's Liberation Army Centre for Haematologic Disorders, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, P.R. China
| | - Wenhui Yang
- Department of Respiratory, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, P.R. China
| | - Ligang Chen
- Department of Neurosurgery, General Hospital of Northern Military Area, Shenyang, China
| | - Guangxun Gao
- Department of Haematology, People's Liberation Army Centre for Haematologic Disorders, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, P.R. China
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18
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Hagiwara M, Panjabi S, Delea T, Yucel E, Fonseca R. Burden of disease progression in patients with multiple myeloma in the US. Leuk Lymphoma 2019; 61:47-55. [PMID: 31389283 DOI: 10.1080/10428194.2019.1648802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Effects of disease progression on healthcare resource utilization (HRU) and costs among multiple myeloma (MM) patients with ≥1 line of therapy (LOT) and without receipt of stem cell transplant were estimated using large US claims database. Disease progression was defined as advancement to the next LOT, bone metastasis, hypercalcemia, soft tissue plasmacytoma, skeletal related events, acute kidney failure, or death within 12 months of LOT initiation. Annual HRU and costs in the first four LOTs were compared for patients with versus without progression using inverse probability of treatment weighting to adjust for differences between groups in baseline characteristics. In all LOTs, mean annual hospitalizations and healthcare costs were greater for patients with versus without progression. Total incremental annual costs among patients with versus without progression in 1LOT to 4LOT were $25,920, $30,632, $47,320, and $19,769, respectively. For MM patients receiving drug therapy, the economic burden of disease progression is substantial.
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Affiliation(s)
| | | | - Tom Delea
- Policy Analysis Inc, Brookline, MA, USA
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19
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Hsieh RW, Go RS, Abeykoon JP, Kapoor P, Kumar SK, Gertz MA, Buadi FK, Leung N, Gonsalves WI, Kourelis TV, Warsame RM, Dispenzieri A, Lacy MQ, Kyle RA, Rajkumar SV, Paludo J. Characteristics of long‐term survivors with multiple myeloma: A National Cancer Data Base analysis. Cancer 2019; 125:3574-3581. [DOI: 10.1002/cncr.32357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/10/2019] [Accepted: 05/26/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Ronan W. Hsieh
- Department of Medicine Albert Einstein Medical Center Philadelphia Pennsylvania
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester Minnesota
| | | | | | | | | | | | - Nelson Leung
- Division of Hematology Mayo Clinic Rochester Minnesota
| | | | | | | | | | | | | | | | - Jonas Paludo
- Division of Hematology Mayo Clinic Rochester Minnesota
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20
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Olry de Labry Lima A, Gimeno-Ballester V, Ríos Tamayo R, Epstein D, Matas Hoces A, Ríos Sánchez E, García Mochón L, Alegre-Del Rey EJ. Cost-effectiveness of lenalidomide maintenance in patients with multiple myeloma who have undergone autologous transplant of hematopoietic progenitor cells. Bone Marrow Transplant 2019; 54:1908-1919. [PMID: 31150015 DOI: 10.1038/s41409-019-0574-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/12/2019] [Accepted: 04/12/2019] [Indexed: 01/25/2023]
Abstract
The objective of this article is to analyze the ratio of cost-effectiveness and budgetary impact of lenalidomide treatment in patients with multiple myeloma who have undergone autologous transplant in Spain. The analyses were based on clinical trials CALGB 100104 and IFM 2005-02, from the perspective of the National Health System. The alternatives compared were the treatment with lenalidomide against maintenance without treatment (MwT). Efficiency measures used were years of life gained (YGs) and quality-adjusted life years (QALYs). According to the CALGB 100104 trial data, the average health costs of patients who were treated with lenalidomide for 120 months was €836,534.31 and without treatment was €528,963.63. The effectiveness of the lenalidomide group was 7.59YGs (5.72 QALY) against 6.58 of MwT (4.61 QALY). The incremental cost-utility ratio (ICUR) was €277,456.72/QALY and the incremental cost-effectiveness ratio was €303,191.05/YGs. From the analysis, the IFM2005-02 trial obtained 5.13 QALY in the lenalidomide group against the 4.98 QALY in the MwT group, with an ICUR of €1,502,780.55/QALY. In terms of budgetary impact, a range between 799 and 1452 patients susceptible to receive treatment with lenalidomide was assumed in Spain. In conclusion, the results show a high ICUR and budgetary impact, which adds uncertainty about the maximum prudent duration of the treatment.
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Affiliation(s)
- Antonio Olry de Labry Lima
- Escuela Andaluza de Salud Pública [Andalusian School of Public Health], Granada, Spain. .,CIBER [Center for Biomedical Research Network] in Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Institute of Biomedical Research (IBS) Granada, University Hospitals of Granada/University of Granada, Granada, Spain.
| | | | - Rafael Ríos Tamayo
- CIBER [Center for Biomedical Research Network] in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Hematology Department, Hospital Virgen de las Nieves, Granada, Spain
| | - David Epstein
- Faculty of Economics, University of Granada, Granada, Spain
| | | | | | - Leticia García Mochón
- Escuela Andaluza de Salud Pública [Andalusian School of Public Health], Granada, Spain.,CIBER [Center for Biomedical Research Network] in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Institute of Biomedical Research (IBS) Granada, University Hospitals of Granada/University of Granada, Granada, Spain
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21
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Hollmann S, Moldaver D, Goyert N, Grima D, Maiese EM. A U.S. Cost Analysis of Triplet Regimens for Patients with Previously Treated Multiple Myeloma. J Manag Care Spec Pharm 2019; 25:449-459. [PMID: 30917078 PMCID: PMC10397865 DOI: 10.18553/jmcp.2019.25.4.449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In recent years, the FDA has approved several 3-agent (i.e., triplet) combinations for previously treated multiple myeloma (MM), and the National Comprehensive Cancer Network (NCCN) now recommends triplet regimens over doublets. Little is known about the real-world cost of triplet combinations because of the limited time that they have been on the market since FDA approval. Furthermore, traditional cost analyses developed to support market entrance rely on utilization assumptions that are difficult to validate when numerous comparators simultaneously enter the market. OBJECTIVE To perform a 1-year cost analysis of novel triplets used for the treatment of patients with previously treated MM controlling for differences in utilization. METHODS FDA-approved, NCCN-recommended (preferred and category 1 for previously treated MM) treatments included in the analysis were daratumumab plus lenalidomide plus dexamethasone (DARA/LEN/DEX), daratumumab plus bortezomib plus dexamethasone (DARA/BOR/DEX), elotuzumab plus lenalidomide plus dexamethasone (ELO/LEN/DEX), carfilzomib plus lenalidomide plus dexamethasone (CAR/LEN/DEX), and ixazomib plus lenalidomide plus dexamethasone (IXA/LEN/DEX). To control for market uptake, the model was designed to estimate the cost of treating an average patient over a 1-year time horizon. Drug administration and dosing, required comedications, postprogression therapy, monitoring requirements, and adverse event (AE) rates were based on FDA prescribing information or clinical trials. AEs ≥ grade 3 that occurred in ≥ 5% of patients were included. RED BOOK wholesale acquisition costs were used for drug acquisition costs. Costs of drug administration, AE management, and patient monitoring were based on the 2018 Center for Medicare & Medicaid Services payment rates or from published literature (inflated to 2018 U.S. dollars). The treatment duration for each regimen was estimated from modeled progression-free survival data; the 12-month progression-free survival rate was assumed to be equivalent to the probability that an average patient remained on therapy for at least 1 year after treatment initiation, which was used to estimate time-depended treatment-related costs. The probability of progression within 1 year of treatment initiation was used to inform the average postprogression therapy costs for each regimen. RESULTS The estimated cost per patient for each triplet regimen was $13,890 (DARA/BOR/DEX), $22,231 (IXA/LEN/DEX), $24,322 (ELO/LEN/DEX), $26,410 (DARA/LEN/DEX), and $27,432 (CAR/LEN/DEX). Drug acquisition costs and treatment duration were the largest drivers of cost. Scenario analyses with plausible alternative input parameters found the maximum per month cost of therapy to be $30,657 (CAR/LEN/DEX) and the minimum per month cost of therapy to be $13,784 (DARA/BOR/DEX). CONCLUSIONS This analysis controlled for differential utilization rates for 5 FDA-approved, NCCN-recommended triplet therapies for the treatment of previously treated MM. Of the examined regimens, treatment with DARA/BOR/DEX was estimated to have the lowest average monthly cost per patient, while CAR/LEN/DEX was the most expensive. As is common with modeling, some assumptions were necessary, and results may not be generalizable. DISCLOSURES This study was funded by Janssen Scientific Affairs, which employs Maiese and funded Cornerstone Research Group, a health economic consulting group, to complete the cost analysis, interpret data, and develop the manuscript. Janssen was involved in the design of the analysis, interpretation of results, and manuscript development and approval. Grima is a founding partner of Cornerstone Research Group, which employs Hollmann, Goyert, and Moldaver. Hollmann, Goyert, and Moldaver were responsible for creation of the economic model. This work was peer-reviewed and presented as an abstract at the Lymphoma and Myeloma 2017 International Congress; October 26-28, 2017; New York, NY.
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Affiliation(s)
| | | | - Nik Goyert
- Cornerstone Research Group, Burlington, Ontario, Canada
| | - Daniel Grima
- Cornerstone Research Group, Burlington, Ontario, Canada
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22
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Gavriatopoulou M, Fotiou D, Ntanasis-Stathopoulos I, Kastritis E, Terpos E, Dimopoulos MA. How I treat elderly patients with plasma cell dyscrasias. Aging (Albany NY) 2018; 10:4248-4268. [PMID: 30568029 PMCID: PMC6326666 DOI: 10.18632/aging.101707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/04/2018] [Indexed: 01/01/2023]
Abstract
Plasma cell dyscrasias are a rare heterogeneous group of hematological disorders which are more prevalent in the older part of the population. The introduction of novel agents, improved understanding of disease biology and better supportive management have improved outcomes considerably and in the era of the aging population the question of how to best manage older patients with plasma cell dyscrasias has never been more relevant. Data on how to treat these patients comes mostly from subgroup analysis as they are underrepresented in clinical trials. This review will cover issues, available evidence and recommendations relevant to diagnosis and management of the older patients with Multiple Myeloma (MM), Waldenstrom Macroglobulinemia (WM) and systemic AL Amyloidosis. What will become increasingly evident is the need to develop and establish the use of disease-specific geriatric assessment (GA) tools. Frailty status assessment using GA tools and moving away from making decisions based merely on chronological age will allow setting clear treatment goals and consequently achieving an optimum balance between effectiveness and toxicity for this complex and heterogeneous group of patients.
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Affiliation(s)
- Maria Gavriatopoulou
- Alexandra Hospital, Oncology Department, Department of Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Equal contribution
| | - Despoina Fotiou
- Alexandra Hospital, Oncology Department, Department of Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Equal contribution
| | - Ioannis Ntanasis-Stathopoulos
- Alexandra Hospital, Oncology Department, Department of Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Efstathios Kastritis
- Alexandra Hospital, Oncology Department, Department of Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Evangelos Terpos
- Alexandra Hospital, Oncology Department, Department of Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Meletios Athanasios Dimopoulos
- Alexandra Hospital, Oncology Department, Department of Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
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23
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Hari P, Lin HM, Zhu Y, Berg D, Richardson PG, Moreau P. Healthcare resource utilization with ixazomib or placebo plus lenalidomide-dexamethasone in the randomized, double-blind, phase 3 TOURMALINE-MM1 study in relapsed/refractory multiple myeloma. J Med Econ 2018; 21:793-798. [PMID: 29741409 DOI: 10.1080/13696998.2018.1474745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS The aim of this analysis was to assess healthcare resource utilization in the pivotal phase 3 TOURMALINE-MM1 study of the oral proteasome inhibitor ixazomib or placebo plus lenalidomide and dexamethasone (Rd) in relapsed and/or refractory multiple myeloma (RRMM). METHODS In this double-blind, placebo-controlled, randomized study (NCT01564537), 722 patients with RRMM following 1-3 prior lines of therapy received Rd plus ixazomib (ixazomib-Rd; n = 360) or matching placebo (placebo-Rd; n = 362) until disease progression or unacceptable toxicity. Healthcare resource utilization data were captured on Day 1 of each 28-day cycle, every 4 weeks during follow-up for progression-free survival, and every 12 weeks during subsequent follow-up, and included medical encounters (length of stay, inpatient, outpatient, and reason) and number of missing days from work or other activities for patients and caregivers. RESULTS Exposure-adjusted rates of hospitalization were similar between the ixazomib-Rd and placebo-Rd arms, at 0.530 and 0.564 per patient year (ppy), respectively, as were outpatient visit rates (3.305 and 3.355 ppy). Mean length of hospitalization per patient was 10.0 and 10.8 days, respectively. In both arms, hospitalization and outpatient visit rates were higher in patients with two or three prior lines of treatment (ixazomib-Rd: 0.632 and 3.909 ppy; placebo-Rd: 0.774 and 3.539 ppy) compared with patients with one prior line (ixazomib-Rd: 0.460 and 2.888 ppy; placebo-Rd: 0.436 and 3.243 ppy). Patients and their caregivers who missed any work or other activity missed a median of 7 and 5 days in the ixazomib-Rd arm, respectively, vs 8 and 4 days with placebo-Rd. LIMITATIONS The study was not powered for a statistical comparison of healthcare resource utilization between treatment arms, nor did it capture costs associated with utilization of the identified healthcare resources. CONCLUSIONS This pre-specified analysis demonstrated that the all-oral triplet regimen of ixazomib added to Rd did not increase healthcare resource utilization compared with placebo-Rd.
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Affiliation(s)
- Parameswaran Hari
- a Department of Medicine, Medical College of Wisconsin , Milwaukee , WI , USA
| | - Huamao Mark Lin
- b Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Yanyan Zhu
- b Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Deborah Berg
- b Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
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24
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Lenalidomide vs bortezomib maintenance choice post-autologous hematopoietic cell transplantation for multiple myeloma. Bone Marrow Transplant 2018; 53:701-707. [PMID: 29703965 DOI: 10.1038/s41409-018-0177-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/18/2018] [Accepted: 03/23/2018] [Indexed: 12/22/2022]
Abstract
Maintenance therapy post-autologous hematopoietic cell transplantation (AHCT) with either lenalidomide or bortezomib for multiple myeloma (MM) have separately been shown to improve progression-free survival (PFS), but have never been directly compared. We performed a retrospective study to investigate progression-free and overall survival outcomes and toxicities of lenalidomide maintenance therapy compared with bortezomib maintenance in MM patients post-AHCT. This study included 156 patients who received post-AHCT lenalidomide or bortezomib maintenance therapy for MM. The primary outcome was PFS. Ninety-two patients received lenalidomide maintenance and 64 received bortezomib maintenance post-AHCT. By multivariable analysis, maintenance therapy choice and cytogenetics risk did not impact PFS or OS. Staging by International Staging System and pre-maintenance disease response were the greatest predictors for PFS. Treatment-related toxicities were as anticipated with 5.4% of patients receiving maintenance lenalidomide experiencing secondary primary malignancies (SPMs) compared with 3% for bortezomib. These findings suggest there were no differences in PFS or OS between lenalidomide and bortezomib maintenance therapy options for post-transplantation MM patients. These data should be validated in a larger, prospective cohort to determine if maintenance choice should be guided by side effect profile and patient anticipated tolerance rather than by disease biology alone.
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Allen PB, Flowers CR. Balancing patient value and payer cost in hematologic malignancies: can it be done? Expert Rev Pharmacoecon Outcomes Res 2018; 18:123-126. [PMID: 29486601 DOI: 10.1080/14737167.2018.1444478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Pamela B Allen
- a Department of Hematology and Medical Oncology , Winship Cancer Institute, Emory University School of Medicine , Atlanta , GA , USA
| | - Christopher R Flowers
- a Department of Hematology and Medical Oncology , Winship Cancer Institute, Emory University School of Medicine , Atlanta , GA , USA
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Quock TP, Yan T, Chang E, Guthrie S, Broder MS. Healthcare resource utilization and costs in amyloid light-chain amyloidosis: a real-world study using US claims data. J Comp Eff Res 2018; 7:549-559. [PMID: 29390860 DOI: 10.2217/cer-2017-0100] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To estimate healthcare utilization and costs in amyloid light-chain (AL) amyloidosis. PATIENTS & METHODS AL amyloidosis patients were identified in 2007-2015 claims databases if they had ≥1 inpatient/≥2 outpatient claims consistent with AL amyloidosis and received ≥1 AL-specific treatment. Descriptive statistics were reported. RESULTS 50.1% (n = 3670) were admitted ≥1 time during the year, 11.3% (n = 827) ≥3 times. From 2007 to 2015, bortezomib use increased from 4.6 to 25.3%; melphalan use decreased from 18.9 to 2.0%; costs increased from 92,866 to $114,030. Among incident patients with at least 2 years of follow-up, healthcare utilization and costs decreased from first to second year post-diagnosis. CONCLUSION AL chemotherapy-based prescribing practices changed. Total annual healthcare costs increased over time among AL amyloidosis patients.
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Affiliation(s)
- Tiffany P Quock
- Prothena Biosciences Inc, 331 Oyster Point Boulevard; South San Francisco, CA 94080, USA
| | - Tingjian Yan
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr. Ste. 404, Beverly Hills, CA 90212, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr. Ste. 404, Beverly Hills, CA 90212, USA
| | - Spencer Guthrie
- Biopharma Strategic Consulting, LLC, 208 2nd Ave, San Francisco, CA 94118, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr. Ste. 404, Beverly Hills, CA 90212, USA
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Maiese EM, Evans KA, Chu BC, Irwin DE. Temporal Trends in Survival and Healthcare Costs in Patients with Multiple Myeloma in the United States. AMERICAN HEALTH & DRUG BENEFITS 2018; 11:39-46. [PMID: 29692879 PMCID: PMC5902764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/01/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND In recent years, the development of new therapies for multiple myeloma has improved the survival of patients, but newer treatments may also affect healthcare costs. To date, no real-world study has examined the concurrent changes in survival and total healthcare costs over time in patients with multiple myeloma. OBJECTIVE To examine the temporal changes in survival and healthcare costs among patients with multiple myeloma in the United States. METHOD This retrospective claims-based cohort study is based on death files in the Truven Health MarketScan Research Commercial and Medicare Supplemental databases. The study included adults who had at least 1 inpatient or 2 outpatient claims with a diagnosis of multiple myeloma between January 1, 2006, and December 31, 2014; continuous insurance enrollment for at least 12 months before and at least 30 days after the first diagnosis (ie, index date); and no previous malignancy. Patients were followed from the index date through the earliest among (1) the date of death recorded in the death files, (2) the end of enrollment in the MarketScan database, or (3) end of the study (September 30, 2015). The mortality rates and the total all-cause and multiple myeloma-specific healthcare costs per patient per month were compared between patients diagnosed in 2006-2010 and those diagnosed in 2011-2014. RESULTS A total of 5199 patients were included in the study (2597 diagnosed between 2006 and 2010 and 2602 diagnosed between 2011 and 2014). We found a 35% decrease in the risk for death (hazard ratio, 0.65; 95% confidence interval, 0.57-0.74) among patients diagnosed in 2011-2014 compared with those diagnosed in 2006-2010. In addition, 18% and 26% increases were found in all-cause and multiple myeloma-specific healthcare costs, respectively, over the same time period (adjusted mean all-cause costs, $13,960 vs $16,449, respectively; adjusted mean multiple myeloma-specific costs, $7476 vs $9422, respectively). CONCLUSION The percent decrease in mortality in patients with multiple myeloma has been greater than the percent increase in healthcare costs in recent years, which may be attributable to improved treatments for multiple myeloma and changes in disease management. With the mortality rate having decreased more than the increase in healthcare costs over the same time period, the results of this study suggest that although healthcare spending has increased over time, there is a survival benefit.
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Affiliation(s)
| | - Kristin A Evans
- Truven Health Analytics, and received research funding from Janssen for this study
| | - Bong-Chul Chu
- Truven Health Analytics, and received research funding from Janssen for this study
| | - Debra E Irwin
- Truven Health Analytics, and received research funding from Janssen for this study
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Hilton R, Zheng Y, Fitzpatrick A, Serban N. Uncovering Longitudinal Health Care Behaviors for Millions of Medicaid Enrollees: A Multistate Comparison of Pediatric Asthma Utilization. Med Decis Making 2018; 38:107-119. [PMID: 29029580 PMCID: PMC5764816 DOI: 10.1177/0272989x17731753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study introduces a framework for analyzing and visualizing health care utilization for millions of children, with a focus on pediatric asthma, one of the major chronic respiratory conditions. METHODS The data source is the 2005 to 2012 Medicaid Analytic Extract claims for 10 Southeast states. The study population consists of Medicaid-enrolled children with persistent asthma. We translate multiyear, individual-level medical claims into sequences of discrete utilization events, which are modeled using Markov renewal processes and model-based clustering. Network analysis is used to visualize utilization profiles. The method is general, allowing the study of other chronic conditions. RESULTS The study population consists of 1.5 million children with persistent asthma. All states have profiles with high probability of asthma controller medication, as large as 60.6% to 90.2% of the state study population. The probability of consecutive asthma controller prescriptions ranges between 0.75 and 0.95. All states have utilization profiles with uncontrolled asthma with 4.5% to 22.9% of the state study population. The probability for controller medication is larger than for short-term medication after a physician visit but not after an emergency department (ED) visit or hospitalization. Transitions from ED or hospitalization generally have a lower probability into physician office (between 0.11 and 0.38) than into ED or hospitalization (between 0.20 and 0.59). CONCLUSIONS In most profiles, children who take asthma controller medication do so regularly. Follow-up physician office visits after an ED encounter or hospitalization are observed at a low rate across all states. Finally, all states have a proportion of children who have uncontrolled asthma, meaning they do not take controller medication while they have severe outcomes.
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Affiliation(s)
- Ross Hilton
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology
| | - Yuchen Zheng
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology
| | | | - Nicoleta Serban
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology
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Alaterre E, Raimbault S, Goldschmidt H, Bouhya S, Requirand G, Robert N, Boireau S, Seckinger A, Hose D, Klein B, Moreaux J. CD24, CD27, CD36 and CD302 gene expression for outcome prediction in patients with multiple myeloma. Oncotarget 2017; 8:98931-98944. [PMID: 29228738 PMCID: PMC5716778 DOI: 10.18632/oncotarget.22131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/27/2017] [Indexed: 12/13/2022] Open
Abstract
Multiple myeloma (MM) is a B cell neoplasia characterized by clonal plasma cell (PC) proliferation. Minimal residual disease monitoring by multi-parameter flow cytometry is a powerful tool for predicting treatment efficacy and MM outcome. In this study, we compared CD antigens expression between normal and malignant plasma cells to identify new potential markers to discriminate normal from malignant plasma cells, new potential therapeutic targets for monoclonal-based treatments and new prognostic factors. Nine genes were significantly overexpressed and 16 were significantly downregulated in MMC compared with BMPC (ratio ≥2; FDR CD24, CD27, CD36 and CD302) was associated with a prognostic value in two independent cohorts of patients with MM (HM cohort and TT2 cohort, n=345). The expression level of these four genes was then used to develop a CD gene risk score that classified patients in two groups with different survival (P = 2.06E-6) in the HM training cohort. The prognostic value of the CD gene risk score was validated in two independent cohorts of patients with MM (TT2 cohort and HOVON65/GMMGHD4 cohort, n=282 patients). The CD gene risk score remained a prognostic factor that separated patients in two groups with significantly different overall survival also when using publicly available data from a cohort of relapsing patients treated with bortezomib (n=188). In conclusion, the CD gene risk score allows identifying high risk patients with MM based on CD24, CD27, CD36 and CD302 expression and could represent a powerful tool for simple outcome prediction in MM.
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Affiliation(s)
- Elina Alaterre
- HORIBA Medical, Parc Euromédecine, Montpellier, France.,Institute of Human Genetics, CNRS-UM UMR9002, Montpellier, France
| | | | - Hartmut Goldschmidt
- Medizinische Klinik und Poliklinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany.,Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - Salahedine Bouhya
- CHU Montpellier, Department of Clinical Hematology, Montpellier, France
| | - Guilhem Requirand
- Department of Biological Haematology, CHU Montpellier, Montpellier, France.,Institute of Human Genetics, CNRS-UM UMR9002, Montpellier, France
| | - Nicolas Robert
- Department of Biological Haematology, CHU Montpellier, Montpellier, France.,Institute of Human Genetics, CNRS-UM UMR9002, Montpellier, France
| | - Stéphanie Boireau
- Department of Biological Haematology, CHU Montpellier, Montpellier, France.,Institute of Human Genetics, CNRS-UM UMR9002, Montpellier, France
| | - Anja Seckinger
- Medizinische Klinik und Poliklinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany.,Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - Dirk Hose
- Medizinische Klinik und Poliklinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany.,Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - Bernard Klein
- Department of Biological Haematology, CHU Montpellier, Montpellier, France.,Institute of Human Genetics, CNRS-UM UMR9002, Montpellier, France.,University of Montpellier, UFR Medecine, Montpellier, France
| | - Jérôme Moreaux
- Department of Biological Haematology, CHU Montpellier, Montpellier, France.,Institute of Human Genetics, CNRS-UM UMR9002, Montpellier, France.,University of Montpellier, UFR Medecine, Montpellier, France
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Alaterre E, Raimbault S, Garcia JM, Rème T, Requirand G, Klein B, Moreaux J. Automated and simplified identification of normal and abnormal plasma cells in Multiple Myeloma by flow cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:484-492. [DOI: 10.1002/cyto.b.21590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/28/2017] [Accepted: 08/30/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Elina Alaterre
- HORIBA Medical; Montpellier France
- Institute of Human Genetics, UMR 9002 CNRS, University of Montpellier; Montpellier F-34396 France
| | | | | | - Thierry Rème
- Department of Biological Hematology; CHU Montpellier; Montpellier France
| | - Guilhem Requirand
- Department of Biological Hematology; CHU Montpellier; Montpellier France
| | - Bernard Klein
- Institute of Human Genetics, UMR 9002 CNRS, University of Montpellier; Montpellier F-34396 France
- Department of Biological Hematology; CHU Montpellier; Montpellier France
- University of Montpellier 1, UFR de Médecine; Montpellier France
| | - Jérôme Moreaux
- Institute of Human Genetics, UMR 9002 CNRS, University of Montpellier; Montpellier F-34396 France
- Department of Biological Hematology; CHU Montpellier; Montpellier France
- University of Montpellier 1, UFR de Médecine; Montpellier France
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Fonseca R, Abouzaid S, Bonafede M, Cai Q, Parikh K, Cosler L, Richardson P. Trends in overall survival and costs of multiple myeloma, 2000-2014. Leukemia 2017; 31:1915-1921. [PMID: 28008176 PMCID: PMC5596206 DOI: 10.1038/leu.2016.380] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/04/2016] [Accepted: 11/14/2016] [Indexed: 12/11/2022]
Abstract
Little real-world evidence is available to describe the recent trends in treatment costs and outcomes for patients with multiple myeloma (MM). Using the Truven Health MarketScan Research Databases linked with social security administration death records, this study found that the percentage of MM patients using novel therapy continuously increased from 8.7% in 2000 to 61.3% in 2014. Compared with MM patients diagnosed in earlier years, those diagnosed after 2010 had higher rates of novel therapy use and better survival outcomes; patients diagnosed in 2012 were 1.25 times more likely to survive 2 years than those diagnosed in 2006. MM patients showed improved survival over the study period, with the 2-year survival gap between MM patients and matched controls decreasing at a rate of 3% per year. Total costs among MM patients have increased in all healthcare services over the years; however, the relative contribution of drug costs has remained fairly stable since 2009 despite new novel therapies coming to market. Findings from this study corroborate clinical data, suggesting a paradigm shift in MM treatment over the past decade that is associated with substantial survival gains. Future studies should focus on the impact on specific novel agents on patients' outcomes.
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Affiliation(s)
| | | | - M Bonafede
- Health Economics and Outcomes Research, Truven Health Analytics Inc., an IBM company, Cambridge, MA, USA
| | - Q Cai
- Health Economics and Outcomes Research, Truven Health Analytics Inc., an IBM company, Cambridge, MA, USA
| | - K Parikh
- Celgene Corporation, Summit, NJ, USA
| | - L Cosler
- Binghamton University, Binghamton, NY, USA
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Hari P, Romanus D, Henk HJ, Becker LK, Noga SJ, Morrison VA. Factors associated with second-line triplet therapy in routine care in relapsed/refractory multiple myeloma. J Clin Pharm Ther 2017; 43:45-51. [PMID: 28833305 DOI: 10.1111/jcpt.12606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/09/2017] [Indexed: 12/12/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Second-line therapy (SLT) trials in relapsed/refractory multiple myeloma (RRMM) report superior outcomes with triplet combinations. We sought to determine factors associated with triplet SLT in routine practice. METHODS A retrospective cohort with claims for MM between 01/01/2008 and 03/31/2015 was grouped by 1-2 ("doublet") or 3+ ("triplet") agent therapy. Charlson comorbidity index (CCI) and disability status; CRAB symptoms (hypercalcaemia, renal/bone disease, anaemia); and relapse risk were determined. RESULTS Among 623 patients, the triplet group (n=146 [23%]) was younger (65.2 vs 69.8 years) and more likely to have high-risk relapse (67% vs 50%), CRAB symptoms (94.5% vs 81.1%), triplet first-line treatment (75% vs 51%) and frontline stem cell transplant (38% vs 20%) (P<0.001 for all). In multivariate analyses, CRAB symptoms (OR: 3.22, 95% CI: 1.47, 7.10), high-risk relapse (OR: 1.71, 95% CI: 1.12, 2.62) and prior triplet therapy (OR: 2.16, 95% CI: 1.38, 3.40), but neither CCI nor disability, were associated with triplet SLT. A trend towards triplets among younger patients (<65 vs >75 years, OR: 1.73, 95% CI: 0.99, 3.04) was observed. WHAT IS NEW AND CONCLUSION The majority of patients did not receive triplet regimens. Treatment selection with triplet therapy for RRMM should carefully consider comorbidities and patient-specific characteristics.
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Affiliation(s)
- P Hari
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - D Romanus
- Takeda Pharmaceuticals International Co., Cambridge, MA, USA
| | | | | | - S J Noga
- Takeda Pharmaceuticals International Co., Cambridge, MA, USA
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MacEwan JP, Batt K, Yin W, Peneva D, Sison S, Vine S, Chen C. Economic burden of multiple myeloma among patients in successive lines of therapy in the United States. Leuk Lymphoma 2017; 59:941-949. [PMID: 28805105 DOI: 10.1080/10428194.2017.1361035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study characterized the costs of multiple myeloma (MM) during first-line (1L), second-line (2L) and third-line (3L) treatment from the US payer perspective. Patients with ≥2 outpatient or ≥1 inpatient claims with a primary MM diagnosis and 12 months continuous enrollment post index were identified in a retrospective claims database between 1 July 2006 and 30 June 2013. A cost per-patient per-month (PPPM) metric was used to calculate total all-cause and anti-MM pharmacy costs in 1L, 2L, and 3L treatment. Of 5704 patients included, 3626 initiated 1L treatment, 1797 initiated 2L and 817 initiated 3L. Average total all-cause PPPM costs were $22,527 in 1L, $35,266 in 2L and $47,417 in 3L. Anti-MM pharmacy costs represented 22%, 29% and 29% of total all-cause costs PPPM in 1L, 2L and 3L, respectively. Study results suggest that delaying 2L and/or 3L treatment initiation may result in lower treatment costs for patients with MM.
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Affiliation(s)
| | - Katharine Batt
- b Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - Wes Yin
- c University of California, Los Angeles , Los Angeles , CA , USA
| | - Desi Peneva
- a Precision Health Economics , Los Angeles , CA , USA
| | - Steve Sison
- a Precision Health Economics , Los Angeles , CA , USA
| | - Seanna Vine
- a Precision Health Economics , Los Angeles , CA , USA
| | - Clara Chen
- d Bristol-Myers Squibb , Princeton , NJ , USA
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Chen Y, Lairson DR, Chan W, Huo J, Du XL. Cost-Effectiveness of Novel Agents in Medicare Patients with Multiple Myeloma: Findings from a U.S. Payer's Perspective. J Manag Care Spec Pharm 2017; 23:831-843. [PMID: 28737990 PMCID: PMC10397941 DOI: 10.18553/jmcp.2017.23.8.831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Since multiple myeloma (MM) incurs a substantial economic burden in care management, more and more discussion has been generated in recent years about the costs of novel antimyeloma drugs and their associated value. Because of these costs, economic assessment that quantifies value of care over the long-term is essential. OBJECTIVE To determine the cost-effectiveness (measured as cost per life-year saved) of front-line novel agent-based therapy use among a cohort of elderly patients with MM in a real-world setting. METHODS We identified 2,551 elderly patients with advanced MM from 2000 to 2009 who initiated novel agent-based therapy (bortezomib, lenalidomide, or thalidomide) or chemotherapy from the Surveillance, Epidemiology, and End Results-Medicare linked data. Patients were characterized according to age at diagnosis, sex, race, geographic region, marital status, socioeconomic status, comorbidities, and receipt of novel agents. Twenty-month cost of care and overall survival related to MM were compared between patients treated with novel agent-based therapy and patients treated with chemotherapy. A net monetary benefit approach and corresponding cost-effectiveness acceptability curves were used to evaluate the cost-effectiveness of novel agent-based therapy. RESULTS Overall, average 12-month MM total costs were 2.03 times higher for novel agent-based therapy ($144,665) than for chemotherapy ($47,750). Antimyeloma pharmacy costs represented about 31% ($45,095) of total MM costs for patients treated with novel agents but represented about 19% ($8,921) of total MM costs for patients treated with chemotherapy. Twelve-month survival rates increased significantly among patients receiving novel agents compared with patients receiving chemotherapy. In the incremental net monetary benefit analysis, after adjusting for potential covariates, patient use of novel agents was only cost-effective compared with chemotherapy when the willingness-to-pay thresholds were high, at about $230,000. CONCLUSIONS Given the most common treatment practices in the United States, the use of novel agent-based therapy is not cost-effective at its current level of cost and effectiveness. Future studies should evaluate the generalizability of these results by evaluating cost-effectiveness of novel agent-based therapy use in different patient populations. DISCLOSURES Funding for this study was contributed by the Agency for Healthcare Research and Quality (R01-H5018956). The authors have nothing to disclose. Study concept and design were contributed by Chen, Lairson, and Du, along with Chan. Chen and Du took the lead in data collection, along with Lairson and Huo. Data interpretation was performed by Chen, Chan, and Du, along with Lairson and Huo. The manuscript was written by Chen, along with Du, Lairson, Chan, and Huo, and revised by primarily by Du, along with Lairson, Huo, Chen, and Chan.
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Affiliation(s)
- Ying Chen
- Department of Epidemiology, Human Genetics, and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston
| | - David R. Lairson
- Department of Management Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston
| | - Wenyaw Chan
- Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston
| | - Jinhai Huo
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xianglin L. Du
- Department of Epidemiology, Human Genetics, and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston
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Robinson D, Orlowski RZ, Stokes M, He J, Huse S, Chitnis A, Kranenburg B, Lam A. Economic burden of relapsed or refractory multiple myeloma: Results from an international trial. Eur J Haematol 2017; 99:119-132. [PMID: 28306169 DOI: 10.1111/ejh.12876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The direct cost of relapsed or refractory multiple myeloma (RRMM) is documented; indirect costs are being explored. Healthcare payers seek cost-offsets from therapies that improve clinical outcomes but challenge budgets; employers seek lower absenteeism and better productivity. Study goals were to: (i) identify direct and indirect economic factors of RRMM, and (ii) explore longitudinal relationships between clinical, economic, and health-related quality of life (HRQoL) assessments. METHODS Economic questionnaire, clinical, and HRQoL data from a multisite, international, randomized, controlled study in RRMM were analyzed. RESULTS Patients (n=263) were 53.6% male, 91.6% Caucasian; mean age of 62.9 years, median Eastern Cooperative Oncology Group status of 1 (56.3%). Moderate to severe pain or fatigue was reported by 30.4% and 70.6%, respectively. At baseline, ≥1 hospitalization was reported by 107 (41.8%); 182 (71.1%) and 86 (33.6%) reported specialist and family physician visits, respectively. A total of 28 (10.8%) were working: 10 (37.0%) of which reported RRMM-driven absenteeism ≥1 day. Of those who were not working, 110 (48.2%) indicated that it was due to RRMM. Multivariate modeling showed lower hospitalization with a major tumor response (β=-1.44, CI: -2.89 to 0.01, P=.05). CONCLUSIONS Substantial RRMM indirect, social costs were observed. Better major tumor response may reduce hospital visits.
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Murtaza G, Lu H, Faqah A, Konowitz N, Kuruvilla A, Adhikari S. Multiple Myeloma-Induced Hyperammonemic Encephalopathy. J Hematol 2017; 6:29-31. [PMID: 32300389 PMCID: PMC7155816 DOI: 10.14740/jh322e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/11/2022] Open
Abstract
Multiple myeloma (MM) typically presents with hypercalcemia, renal insufficiency, anemia, and bone lesions. Elevated ammonia level manifesting as altered mental status is a rare complication in MM. We report an interesting case of hyperammonemic encephalopathy in a 73-year-old male with advanced relapsing kappa-light chain MM.
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Affiliation(s)
- Ghulam Murtaza
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Hannah Lu
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Anadil Faqah
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Nicholas Konowitz
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Aneesh Kuruvilla
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Sujeen Adhikari
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
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Palmaro A, Gauthier M, Conte C, Grosclaude P, Despas F, Lapeyre-Mestre M. Identifying multiple myeloma patients using data from the French health insurance databases: Validation using a cancer registry. Medicine (Baltimore) 2017; 96:e6189. [PMID: 28328805 PMCID: PMC5371442 DOI: 10.1097/md.0000000000006189] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to assess the performance of several algorithms based on hospital diagnoses and the long-term diseases scheme to identify multiple myeloma patients.Potential multiple myeloma patients in 2010 to 2013 were identified using the presence of hospital records with at least 1 main diagnosis code for multiple myeloma (ICD-10 "C90"). Alternative algorithms also considered related and associated diagnoses, combination with long-term conditions, or at least 2 diagnoses. Incident patients were those with no previous "C90" codes in the past 24 or 12 months. The sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) were computed, using a French cancer registry for the corresponding area and period as the criterion standard.Long-term conditions data extracted concerned 11,559 patients (21,846 for hospital data). The registry contained 125 cases of multiple myeloma. Sensitivity was 70% when using only main hospital diagnoses (specificity 100%, PPV 79%), 76% when also considering related diagnoses (specificity 100%, PPV 74%), and 90% with associated diagnoses included (100% specificity, 64% PPV).In relation with their good performance, selected algorithms can be used to study the benefit and risk of drugs in treated multiple myeloma patients.
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Affiliation(s)
- Aurore Palmaro
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital
- INSERM 1027, University of Toulouse
- CIC 1436, Toulouse University Hospital
| | | | - Cécile Conte
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital
- INSERM 1027, University of Toulouse
| | - Pascale Grosclaude
- INSERM 1027, University of Toulouse
- Tarn Cancer Registry, Albi
- French Network of Cancer Registries (FRANCIM), France
| | - Fabien Despas
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital
- INSERM 1027, University of Toulouse
- CIC 1436, Toulouse University Hospital
| | - Maryse Lapeyre-Mestre
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital
- INSERM 1027, University of Toulouse
- CIC 1436, Toulouse University Hospital
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Princic N, Gregory C, Willson T, Mahue M, Felici D, Werther W, Lenhart G, Foley KA. Development and Validation of an Algorithm to Identify Patients with Multiple Myeloma Using Administrative Claims Data. Front Oncol 2016; 6:224. [PMID: 27833899 PMCID: PMC5081355 DOI: 10.3389/fonc.2016.00224] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/10/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The objective was to expand on prior work by developing and validating a new algorithm to identify multiple myeloma (MM) patients in administrative claims. METHODS Two files were constructed to select MM cases from MarketScan Oncology Electronic Medical Records (EMR) and controls from the MarketScan Primary Care EMR during January 1, 2000-March 31, 2014. Patients were linked to MarketScan claims databases, and files were merged. Eligible cases were age ≥18, had a diagnosis and visit for MM in the Oncology EMR, and were continuously enrolled in claims for ≥90 days preceding and ≥30 days after diagnosis. Controls were age ≥18, had ≥12 months of overlap in claims enrollment (observation period) in the Primary Care EMR and ≥1 claim with an ICD-9-CM diagnosis code of MM (203.0×) during that time. Controls were excluded if they had chemotherapy; stem cell transplant; or text documentation of MM in the EMR during the observation period. A split sample was used to develop and validate algorithms. A maximum of 180 days prior to and following each MM diagnosis was used to identify events in the diagnostic process. Of 20 algorithms explored, the baseline algorithm of 2 MM diagnoses and the 3 best performing were validated. Values for sensitivity, specificity, and positive predictive value (PPV) were calculated. CONCLUSION Three claims-based algorithms were validated with ~10% improvement in PPV (87-94%) over prior work (81%) and the baseline algorithm (76%) and can be considered for future research. Consistent with prior work, it was found that MM diagnoses before and after tests were needed.
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Affiliation(s)
| | | | | | - Maya Mahue
- Onyx Pharmaceuticals Inc., An Amgen Subsidiary , San Francisco, CA , USA
| | - Diana Felici
- Onyx Pharmaceuticals Inc., An Amgen Subsidiary , San Francisco, CA , USA
| | - Winifred Werther
- Onyx Pharmaceuticals Inc., An Amgen Subsidiary , San Francisco, CA , USA
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Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial Hardships Experienced by Cancer Survivors: A Systematic Review. J Natl Cancer Inst 2016; 109:djw205. [PMID: 27754926 DOI: 10.1093/jnci/djw205] [Citation(s) in RCA: 503] [Impact Index Per Article: 62.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 08/05/2016] [Indexed: 01/09/2023] Open
Abstract
Background With rising cancer care costs, including high-priced cancer drugs, financial hardship is increasingly documented among cancer survivors in the United States; research findings have not been synthesized. Methods We conducted a systematic review of articles published between 1990 and 2015 describing the financial hardship experienced by cancer survivors using PubMed, Embase, Scopus, and CINAHL databases. We categorized measures of financial hardship into: material conditions (eg, out-of-pocket costs, productivity loss, medical debt, or bankruptcy), psychological responses (eg, distress or worry), and coping behaviors (eg, skipped medications). We abstracted findings and conducted a qualitative synthesis. Results Among 676 studies identified, 45 met the inclusion criteria and were incorporated in the review. The majority of the studies (82%, n = 37) reported financial hardship as a material condition measure; others reported psychological (7%, n = 3) and behavioral measures (16%, n = 7). Financial hardship measures were heterogeneous within each broad category, and the prevalence of financial hardship varied by the measure used and population studied. Mean annual productivity loss ranged from $380 to $8236, 12% to 62% of survivors reported being in debt because of their treatment, 47% to 49% of survivors reported experiencing some form of financial distress, and 4% to 45% of survivors did not adhere to recommended prescription medication because of cost. Conclusions Financial hardship is common among cancer survivors, although we found substantial heterogeneity in its prevalence. Our findings highlight the need for consistent use of definitions, terms, and measures to determine the best intervention targets and inform intervention development in order to prevent and minimize the impact of financial hardship experienced by cancer survivors.
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Affiliation(s)
- Cheryl K Altice
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | - Reginald D Tucker-Seeley
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.,Center for Community Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - K Robin Yabroff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Costa LJ, Brill IK, Brown EE. Impact of marital status, insurance status, income, and race/ethnicity on the survival of younger patients diagnosed with multiple myeloma in the United States. Cancer 2016; 122:3183-3190. [PMID: 27548407 DOI: 10.1002/cncr.30183] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/16/2016] [Accepted: 06/07/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent advances in the treatment of multiple myeloma (MM) have been associated with improved survival, predominantly among young and white patients. The authors hypothesized that sociodemographic factors, adjusted for race/ethnicity, influence the survival of younger patients with MM. METHODS Overall survival (OS) data were obtained for individuals included in the Surveillance, Epidemiology, and End Results (SEER-18) program who were diagnosed with MM before the age of 65 years between 2007 and 2012. The sociodemographic variables addressed were marital status, insurance status, median household income, and educational achievement in the county of residence. Race/ethnicity was defined as a self-reported construct including Hispanic (regardless of race), non-Hispanic black, non-Hispanic white, and other. RESULTS There were 10,161 cases of MM included with a median follow-up of 27 months (range, 0-71 months; 22,179 person-years). Using multivariable Cox proportional hazards analysis, SEER registry; age; male sex; and 3 sociodemographic factors including marital status (other than married), insurance status (uninsured or Medicaid), and county-level income (lowest 2 quartiles), but not race/ethnicity, were found to be associated with an increased risk of death. The 4-year estimated OS rate was 71.1%, 63.2%, 53.4%, and 46.5% (P<.001), respectively, for patients with 0, 1, 2, or 3 adverse sociodemographic factors. Hispanic and non-Hispanic black individuals were found to have more adverse sociodemographic factors and worse OS. However, when the population was stratified by the cumulative number of sociodemographic factors, no consistent association between race/ethnicity and OS was observed after adjustment for confounders. CONCLUSIONS Sociodemographic factors that potentially affect care, but not race/ethnicity, were found to influence the survival of younger patients with MM. Cancer 2016;122:3183-90. © 2016 American Cancer Society.
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Affiliation(s)
- Luciano J Costa
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. .,University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.
| | - Ilene K Brill
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth E Brown
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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Chen W, Yang Y, Chen Y, Du F, Zhan H. Cost-effectiveness of bortezomib for multiple myeloma: a systematic review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:137-51. [PMID: 27217786 PMCID: PMC4861606 DOI: 10.2147/ceor.s104195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To review published cost-effectiveness analyses (CEA) assessing bortezomib (BTZ) for multiple myeloma (MM) and explore possible bias affecting the cost-effectiveness of BTZ. METHODS Literature was searched for published CEAs assessing BTZ or BTZ-containing regimens for MM from 2003 to 2015. The reported incremental cost-effectiveness ratios (ICER) were adjusted by 2014 country-specific gross domestic product per capita (GDPPC) to compare the cost-effectiveness threshold of the World Health Organization (3 GDPPC per gained quality-adjusted life year [QALY]). RESULTS A total of 17 published CEAs were included in this review. When compared to non-BTZ treatments, BTZ-containing regimens were cost-effective for induction treatment prior to stem cell transplantation (SCT) in Canada, Poland, and Germany (ICER per QALY: 0.9299-2.254 GDPPC). BTZ/melphalan/prednisolone (VMP) was cost-effective for previously untreated and SCT-ineligible MM patients when compared to melphalan plus prednisolone (MP), melphalan/prednisone/lenalidomide with lenalidomide maintenance, and cyclophosphamide/thalidomide/dexamethasone (CTD) (ICER per QALY: dominant to 2.374 GDPPC) in Canada, UK, and USA. BTZ was cost-effective for relapsed/refractory MM when compared to best supportive care (ICER per life year: 0.9317-1.8210 GDPPC) in the UK and the USA, thalidomide in USA (0.5178 GDPPC/LY), and dexamethasone (DEX) in four Nordic countries (€54,451-€81,560/QALY). However, the cost-effectiveness for VMP versus MP plus thalidomide (MPT) and continuous lenalidomide (LEN) plus low-dose DEX (RD) for previously untreated and SCT-ineligible MM patients and BTZ versus LEN/DEX for relapsed/refractory MM patients could be unreliable because of the bias associated with model design and the indirect comparisons of treatment effects. CONCLUSION Published CEAs suggested that BTZ or BTZ-containing regimens were cost-effective when compared to most non-BTZ treatments for MM. However, the conflicting cost-effectiveness for VMP versus MPT for previously untreated and SCT-ineligible MM and BTZ versus LEN/DEX for relapsed/refractory MM needs more robust evidence for further clarification.
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Affiliation(s)
| | - Yicheng Yang
- Xian Janssen, Beijing, People’s Republic of China
| | - Yi Chen
- Normin Health Changsha Representative Office, Changsha, People’s Republic of China
| | - Fen Du
- Normin Health Changsha Representative Office, Changsha, People’s Republic of China
| | - Huan Zhan
- Normin Health Changsha Representative Office, Changsha, People’s Republic of China
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Wildes TM, Campagnaro E. Management of multiple myeloma in older adults: Gaining ground with geriatric assessment. J Geriatr Oncol 2016; 8:1-7. [PMID: 27118356 DOI: 10.1016/j.jgo.2016.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/28/2015] [Accepted: 04/05/2016] [Indexed: 01/22/2023]
Abstract
Multiple myeloma increases in incidence with age. With the aging of the population, the number of cases of multiple myeloma diagnosed in older adults each year will nearly double in the next 20years. The novel therapeutic agents have significantly improved survival in older adults, but their outcomes remain poorer than in younger patients. Older adults may be more vulnerable to toxicity of therapy, resulting in decreased dose intensity and contributing to poorer outcomes. Data are beginning to emerge to aid in identifying which individuals are at greater risk for toxicity of therapy; comorbidities, functional limitations, and age over 80years are among the factors associated with greater risk. Geriatric assessment holds promise in the care of older adults with multiple myeloma, both to allow modification of treatment to prevent toxicity, and to identify vulnerabilities that may require intervention. Emerging treatments with low toxicity and attention to individualizing therapy based on geriatric assessment may aid in further improving outcomes in older adults with multiple myeloma.
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Affiliation(s)
- Tanya M Wildes
- Washington University School of Medicine, St. Louis, MO, USA.
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Raedler LA. Darzalex (Daratumumab): First Anti-CD38 Monoclonal Antibody Approved for Patients with Relapsed Multiple Myeloma. AMERICAN HEALTH & DRUG BENEFITS 2016; 9:70-3. [PMID: 27668047 PMCID: PMC5013856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Raedler LA. Empliciti (Elotuzumab): First SLAMF7 Antibody Therapy Approved for the Treatment of Patients with Previously Treated Multiple Myeloma. AMERICAN HEALTH & DRUG BENEFITS 2016; 9:74-7. [PMID: 27668048 PMCID: PMC5013854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Raedler LA. Kyprolis (Carfilzomib) Received New Indications as Combination Therapy for Use in Relapsed and/or Refractory Multiple Myeloma. AMERICAN HEALTH & DRUG BENEFITS 2016; 9:93-6. [PMID: 27668053 PMCID: PMC5013842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Zhou X, Xia J, Mao J, Cheng F, Qian X, Guo H. Real-world outcome and healthcare costs of relapsed or refractory multiple myeloma: A retrospective analysis from the Chinese experience. Hematology 2016; 21:280-6. [PMID: 26900623 DOI: 10.1080/10245332.2015.1122259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Xin Zhou
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Jun Xia
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Jingjue Mao
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Feng Cheng
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Xifeng Qian
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Hongfeng Guo
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
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Raedler LA. Ninlaro (Ixazomib): First Oral Proteasome Inhibitor Approved for the Treatment of Patients with Relapsed or Refractory Multiple Myeloma. AMERICAN HEALTH & DRUG BENEFITS 2016; 9:102-105. [PMID: 27668055 PMCID: PMC5013850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Raedler LA. Revlimid (Lenalidomide) Now FDA Approved as First-Line Therapy for Patients with Multiple Myeloma. AMERICAN HEALTH & DRUG BENEFITS 2016; 9:140-3. [PMID: 27668061 PMCID: PMC5013840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Raedler LA. Pomalyst (Pomalidomide) Received a New Indication for Patients with Relapsed and/or Refractory Multiple Myeloma. AMERICAN HEALTH & DRUG BENEFITS 2016; 9:111-4. [PMID: 27668057 PMCID: PMC5013859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Nash Smyth E, Conti I, Wooldridge JE, Bowman L, Li L, Nelson DR, Ball DE. Frequency of skeletal-related events and associated healthcare resource use and costs in US patients with multiple myeloma. J Med Econ 2016; 19:477-86. [PMID: 26671598 DOI: 10.3111/13696998.2015.1132225] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A potential complication for all new multiple myeloma (MM) patients is the clinical presentation of osteolytic lesions which increase the risk for skeletal-related events (SREs). However, the contribution of SREs to the overall economic impact of MM is unclear. The impact of SREs on healthcare resource utilization (HCRU) and costs for US patients with MM was analyzed in Truven Health Marketscan Commercial Claims and Medicare Supplemental Databases. METHODS Adults diagnosed with MM between January 1, 2005 and December 31, 2010 with ≥2 claims ≥30 days apart (first claim = index date) were included. SREs included: hypercalcemia, pathologic fracture, surgery for the prevention and treatment of pathologic fractures or spinal cord compression, and radiation for bone pain. Rates of HCRU (outpatient [OP], inpatient [IP], emergency room [ER], orthopedic consultation [OC], and ancillary) and healthcare costs were compared between MM patients with and without SREs. Inverse propensity weighting was applied to adjust for potential bias. RESULTS Of 1028 MM patients (mean age = 67, standard deviation = 13.2), 596 patients with ≥1 SRE and 432 without SREs were assessed. HCRU rates in IP, ER, and ancillary (p < 0.01) and mean total costs of OP, IP, and ER were significantly higher (p < 0.05) for patients with vs without SREs during follow-up. HCRU rates also increased with SRE frequency (p < 0.05 in OP, IP, ER, OC, and ancillary), as did mean total healthcare costs, except for OC (p < 0.001). LIMITATIONS A broad assessment of pharmacotherapy for the treatment of MM was not an objective of the current study. Bisphosphonate use was evaluated; however, results were descriptively focused on frequency of utilization only and were not included in the broader cost and HCRU analysis. CONCLUSIONS Among US patients with MM, higher SRE frequency was associated with a significant trend of higher HCRU and total healthcare costs in several settings.
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Affiliation(s)
| | - Ilaria Conti
- a Eli Lilly and Company , Indianapolis , IN , USA
| | | | - Lee Bowman
- a Eli Lilly and Company , Indianapolis , IN , USA
| | - Li Li
- a Eli Lilly and Company , Indianapolis , IN , USA
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