Real World Management of Multiple Myeloma in Asia: Treatment Pattern and Cost

Introduction:

Multiple myeloma (MM) is the second most common hematologic malignancies in the world. New approved therapeutic agents have improved the survival rates of myeloma patients. However, it is often unclear what is the best treatment in different settings, and the treatment cost is rising. In this study, we assess the way MM is treated in a developed country in Asia.

Methods:

A retrospective study of newly diagnosed MM patients from June 2009 to April 2017 from Singapore was conducted. The analysis focused on the age of patient, medication regimes used for different lines of treatment, whether autologous stem cell transplant (SCT) was received and the estimated cost of treatment. Treatment free period (TFP) was measured as time from the end date of previous treatment to the start date for the next treatment. The time to next treatment (TTNT) was measured from the start date of the first treatment to the start date of the next line of treatment.

Results:

A total of 143 patients were included in the analysis. Among the 96 (67.1%) patients under 65 years old, only 73 (76%) received autologous SCT treatment. Overall, 56 (39.2%) of the patients progressed and received second (2^nd) line treatment, while 21 (14.7%) and 9 (6.3%) received 3^rd and 4^th line treatment respectively. The most frequently used drugs for 1^st line treatment were Bortezomib (75.5%), Dexamethasone (87.4%), Thalidomide (63.6%) and Cyclophosphamide (53.8%). This reflects that the 2 most commonly used regimens for 1^st line treatment are VCD and VTD. For 2^nd line treatment, Lenalidomide (50%) and Dexamethasone (94.6%) were the main drugs used, reflecting that RD was the predominant regimen used in this phase. For 3^rd line treatment, Dexamethasone (100%), Pomalidomide (38.1%), Cyclophosphamide (33.3%) and Lenalidomide (33.3 %) were the main drugs used.

Focusing on individual drugs, while Lenalidomide was only used 7.7% of the time for 1^st line treatment, usage increased to 50% and 33.3% for 2^nd and 3^rd line treatment respectively. For Pomalidomide, while usage was low at 0% and 7.1% for 1^st and 2^nd line treatment respectively, it increased to 38.1% for 3^rd line treatment. Bortezomib, Thalidomide and Cyclophosphamide were predominantly used as 1^st line treatment choices, with usage rates of 75.5%, 63.6% and 53.8% respectively. Their usage rates were significantly reduced in 2^nd and 3^rd line treatment.

The average treatment cost per TFP (weeks) among 56 patients who progressed to 2^nd line treatment was $673.81/week. The average cost increased to $2,239/week and $11,556.56/week for the patients who received 3^rd and 4^th line treatment respectively. For SCT patients (30 patients progressed to 2^nd line, 7 patients to 3^rd line, and 4 patients to 4^th line), the average cost per TFP was $705.87/week, $2,078.66/week and $35,854.20/week for 2^nd, 3^rd and 4^th line of treatment respectively. For non-SCT patients (26 patients progressed to 2^nd line, 14 patients to 3^rd line, and 5 patients to 4^th line), the average cost per TFP was $603.64/week, $2,333.25/week and $5,959.72/week for 2^nd, 3^rd and 4^th line of treatment respectively.

The average TTNT per patient for 1^st, 2^nd and 3^rd treatment line progression was 128.8, 58.7 and 75.5 weeks respectively. The average TTNT per SCT patient was 142.4, 65.6 and 74.9 weeks for 1^st, 2^nd and 3^rd treatment line progression respectively, as compared to 113.1, 55.2 and 75.9 weeks for non-SCT patients. Overall, the average treatment cost per week of TTNT was $409.18, $798.10 and $2,167.92 for 1^st, 2^nd and 3^rd treatment line progression respectively - the average cost for SCT patients was $496.91, $736.23 and $2,855.34, while the average cost for non-SCT patients was $281.81, $834.81 and $1,625.58 respectively.

Conclusions:

Treatment for multiple myeloma remains expensive. While the benefits of subsequent lines of treatment decreases, the average treatment cost increases. With the increasing availability of expensive but yet more effective treatments, these could be incorporated early into the treatment regimen to maximise therapeutic benefit. Despite the higher cost of these drugs, cost-effectiveness could be improved, or at least remain similar if TTNT can be greatly prolonged.

Figure

View largeDownload slide

Figure

View largeDownload slide

Close modal