Healthcare Resource Utilization High in Patients with Relapsed or Refractory Multiple Myeloma

August 2016 Vol 9, Special Issue: Payers' Perspectives in Oncology
Chase Doyle

 A study evaluating the economic burden associated with multiple myeloma and its treatment has found that routine management and disease progression continues to drive healthcare resource utilization, regardless of the number of previous lines of therapy. Other key drivers of healthcare utilization in multiple myeloma are hospitalizations, transplantations, and concomitant medication use. The study was presented at ASCO 2016.

“Preliminary assessment suggests that the early use of immunomodulatory drugs leads to lower healthcare resource utilization costs. However, further analyses on our heterogeneous population are required to better understand the drivers,” said David Cella, PhD, Director, Institute for Public Health and Medicine-Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL.

“The early use of novel therapies with the potential to provide durable responses could improve the management of multiple myeloma and patient outcomes,” Dr Cella added.

Several novel treatment options for multiple myeloma have become available in recent years, including proteasome inhibitors and immunomodulatory drugs (IMiDs).

“The current clinical practice guidelines recommend the use of a PI [proteasome inhibitor], IMiD, or a combination regimen for treatment of relapsed or refractory multiple myeloma, but robust data on the real-world effectiveness of these treatments are needed,” he said.

PREAMBLE: Real-World Cohort Study

The PREAMBLE study enrolled ­patients with relapsed or refractory multiple myeloma (aged ≥18 years) who received at least 1 previous line of therapy.

All the patients initiated treatment with an IMiD, proteasome inhibitor, or a combination of both either 90 days before or 30 days after study enrollment.

At the data cutoff in April 2016, 855 patients were enrolled in the study. The median follow-up was 16.7 months, and the median time from diagnosis to receiving the index therapy was 40 months.

The median previous lines of therapy was 2, with 412 (48%) patients having had transplantation.

Of the 855 patients, 49% were receiving an IMiD, 44% a proteasome inhibitor, and 7% were receiving a combination of both as index therapy at study entry. Lenalidomide was the most common IMiD (80%) given, bortezomib was the most common proteasome inhibitor (81%), and lenalidomide plus bortezomib was the most common combination regimen (53%), followed by pomalidomide plus carfilzomib (17%).

Resource Utilization

The data were collected at each provider visit, including the type of visit and hospitalizations. In year 1, the median number of provider visits for all patients was 4. In years 2 and 3, the median number of visits was 2, with similar frequency across the index therapy types.

Of 8286 total provider visits, the most common was hospital outpatient visits (N = 3805; 46%), followed by a clinic or physician office visit (N = 3212; 39%); there were 507 total hospitalizations.

The management of multiple myeloma was the main reason for provider visits in approximately 90% of visits, regardless of the index therapy type.

The management of treatment-related adverse events accounted for 9% of the provider visits and 34% of the hospitalizations.

In patients with 1, 2, or 3 previous lines of therapy for multiple myeloma, the median number of visits in year 1 was 4. With more than 3 previous lines of therapy, the median visits increased to 8.

In the 255 patients who received an IMiD as frontline therapy, the median number of visits in year 1 was also 8, but that number decreased to 2.5 visits in years 2 and 3.

In the 338 patients who received a proteasome inhibitor as frontline therapy, the median number of visits was 5 in year 1, which decreased to 2.3 visits in years 2 and 3.

Dr Cella noted that this cost analysis demonstrated that drug therapy contributed 79% of the total annual healthcare resource utilization cost. The median overall annual treatment cost ($1000) was lower with an IMiD as frontline therapy than with a proteasome inhibitor.

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