Multiple Myeloma: Patient out-of-Pocket Costs and Health Care Utilization.

Multiple myeloma (MM) is a complex disease that places a significant burden on patients and their caregivers. Novel agents have different administration methods (oral versus intravenous [IV]) and differ in terms of patient convenience (such as number of visits) and costs. This study compared the burden of patient visits and out-of-pocket costs for MM patients treated with bortezomib (BOR; Velcade^®; IV administration), lenalidomide (LEN; Revlimid^®; oral), thalidomide (THAL; Thalomid^®; oral), or other unspecified chemotherapies or radiation therapy.

This retrospective cohort study used claims data from a large national US commercial health plan representing approximately 14 million members. Patients aged ³18 yrs, diagnosed with MM between January 1 2005 and September 30 2007, and treated with BOR, LEN, THAL, or other unspecified chemotherapies or radiation therapy during this period were included in the study. Patient costs and resource utilization data were analyzed at the treatment level. Treatment episodes (defined as each course of therapy) were identified from records for each patient; some patients had multiple episodes. Health care utilization (according to number of ambulatory patient visits) and inflation-adjusted patient out-of-pocket costs, including co-pays and deductibles, were examined for 1 yr from the beginning of each treatment episode. An ambulatory visit was defined as any visit with a unique day and a unique provider ID in an outpatient or office setting. Descriptive analyses were supplemented with multivariate regression analyses to control for patient characteristics, comorbidities, and line of treatment (more prior lines of therapy are indicative of more advanced disease).

A total of 2,642 treatment episodes were identified for the 1,900 MM patients included in the study. The majority of episodes were classified as “other chemotherapy or radiation therapy” (n=1,759, 66.6%). The second most common treatment episode was THAL (n=549, 20.8%), followed by BOR (n=244, 9.2%) and LEN (n=90, 3.4%). There were no differences among treatment groups in terms of inpatient or emergency room visits in the year following treatment initiation. As expected, patients treated with BOR appeared to have more ambulatory visits compared with patients treated with LEN, which is administered orally; however, this difference was not significant after adjustment for patient characteristics, line of treatment, and comorbidities by multivariate analysis (Table). The total adjusted patient out-of-pocket costs for the year after treatment initiation were significantly less for patients treated with BOR ($3,504) than for those treated with THAL ($4,443, p<0.05) or LEN ($4,766, p<0.05) (Table). These differences were greatest for Medicare patients, with the adjusted patient costs of THAL ($8,824) and LEN ($12,568) respectively, nearly 2 and 3 times greater than the adjusted costs of BOR ($4,395).

In this study, the perceived advantage of orally administered drugs (THAL, LEN) in terms of fewer patient visits was not significant. In addition, direct out-of-pocket costs were significantly higher for patients treated with the oral drugs THAL and LEN compared with the IV drug BOR, especially for Medicare patients, likely due to the Coverage Gap, commonly known as the “donut hole”, in Medicare Part D.

Huang: Milllennium: Employment, Equity Ownership. Teitelbaum: Spectrum Pharmaceuticals: Consultancy; EGEN: Consultancy, Honoraria; CV Therapeutics: Consultancy. Esseltine: Milllennium: Employment, Equity Ownership.