Healthcare resource utilization among patients with relapsed multiple myeloma in the UK, France, and Italy

Abstract

Aims: To assess the real-world healthcare resource utilization (HRU) and costs associated with different treatment regimens used in the management of patients with relapsed multiple myeloma in the UK, France, and Italy.

Methods: Retrospective medical chart review of characteristics, time to progression, level of response, HRU during treatment, and adverse events (AEs). Data collection started on June 1, 2015 and was completed on July 15, 2015. In the 3 months before record abstraction, eligible patients had either disease progression after receiving one of their country’s most commonly prescribed regimens or had received the best supportive care and died. Costs were calculated based on HRU and country-specific diagnosis-related group and/or unit reference costs, amongst other standard resources.

Results: Physicians provided data for 1,282 patients (387 in the UK, 502 in France, 393 in Italy) who met the inclusion criteria. Mean [median] total healthcare costs associated with a single line of treatment were €51,717 [35,951] in the UK, €37,009 [32,538] for France, and €34,496 [42,342] for Italy, driven largely by anti-myeloma medications costs (contributing 95.0%, 90.0%, and 94.2% of total cost, respectively). During active treatment, the highest costs were associated with lenalidomide- and pomalidomide-based regimens. Mean cost per month was lowest for patients achieving a very good partial response or better. Unscheduled events (i.e. not considered part of routine management, whether or not related to multiple myeloma, such as unscheduled hospitalization, AEs, fractures) accounted for 1–9% of total costs and were highest for bendamustine.

Limitations: The use of retrospective data means that clinical practice (e.g. use of medical procedures, evaluation of treatment response) is not standardized across participating countries/centers, and some data (e.g. low-grade AEs) may be incomplete or differently adjudicated/reported. The centers involved may not be fully representative of national practice.

Conclusions: Drug costs are the main contributor to total HRU costs associated with multiple myeloma. The duration of active treatment may influence the average total costs, as well as response, associated with a single line of therapy. Improved treatment outcomes, and reductions in unscheduled events and concomitant medication use may, therefore, reduce the overall HRU and related costs of care in multiple myeloma.

Keywords:

• Healthcare resource utilization
• relapsed multiple myeloma
• costs
• real-world
• HRU

Transparency

Declaration of funding

This study was funded by Amgen (Europe) GmbH.

Declaration of financial/other relationships

SG-M, PS, MC, and LDC are employees of Amgen and hold Amgen stock. KY has received honoraria from Amgen, Janssen-Cilag, Novartis, Celgene, and MorphoSys. HL and FSM have received honoraria from Amgen. AF, CG, and LF were paid by Amgen to conduct the study. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Medical writing support was provided by Kim Allcott, PhD and Liz Hartfield, PhD of Oxford PharmaGenesis Ltd, which was funded by Amgen (Europe) GmbH.

Previous presentations

Part of these analyses were presented at the International Society for Pharmacoeconomics and Outcomes Research 21st Annual Meeting, May 21–25, 2016, Washington, DC, USA and at the European Hematology Association 21st Annual Meeting, June 9–12, 2016, Copenhagen, Denmark.