Economics of Multiple Myeloma

Background

Multiple myeloma (MM) accounts for about 10% of hematologic malignancies, and the 5-year survival rate of patients diagnosed with multiple myeloma has increased by 14% over the past two decades with median survivals between 29-62 months. Improvements in survival has been attributable to improved therapeutics, representing a significant expenditure within the healthcare system. We seek to quantify the cost for caring for patients with MM from a third-party perspective.

Methods

We conducted a descriptive retrospective cohort costing study using administrative data from the Cancer Measurement Outcomes Research and Evaluations (C-MORE) at the Tom Baker Cancer Centre (TBCC). We identified incident cases of patients diagnosed with symptomatic multiple myeloma between 01 Jan 2002 and 31 Dec 2014. Demographic data were obtained together with their contact points with the healthcare system, including inpatient visits and lengths of stay, outpatient visits diagnostic and treatment visits, as well as medication usage. Using the Alberta Health Hospital Reciprocal Claim Guide and local pharmacy costs at TBCC, we assigned costs to health care utilization for incident cases of MM between our study period. Further, we stratified our data into 3 cohorts: 2002-2005, 2006-2010 and 2011-2014 to better appreciate secular trends.

Results

We identified 806 patients, but excluded 284 patients (35%) due to absence of data. The median duration of follow-up of the remaining cohort was 46 months (range 1-172). The median number of lines of therapy is 2 (range 1-8) with 32% overall enrolled in at least one clinical study. Table 1 details the cohort demographics with an overall survival (OS) of cohort of 55% (median survival of 81 months, 95% CI=68-94). The average cost of care per patient per year is $49,077, with $30,895, $46,333, $69,627 for Cohorts 1, 2 and 3 respectively. Chemotherapy (not including clinical trial medications) costs represents the largest cost-item.

Conclusions

Our study suggests that the survival of patients with MM diagnosed at the TBCC has improved consistent with the literature, but with an increasing cost of care. Despite incomplete administrative data from C-MORE, the current available data could help support health care Administrators better prioritize health care resources.

Table 1.

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Table 1.

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