Healthcare utilization and costs among relapsed or refractory multiple myeloma patients on carfilzomib or pomalidomide as monotherapy or in combination with dexamethasone

Abstract

Aim: To compare monthly healthcare resource utilization (HRU) and costs among adult patients with multiple myeloma (MM) receiving second or subsequent line of treatment (LOT) with carfilzomib or pomalidomide as monotherapy or in combination with dexamethasone.

Methods and materials: Adult MM patients who received carfilzomib or pomalidomide as second/subsequent LOT between 2006 and 2014 were selected from the MarketScan databases. LOT was determined using Medical/pharmacy claims using a published algorithm. For each patient, first LOT with carfilzomib or pomalidomide was defined as index LOT. Patients with first LOT as index LOT, who received other chemotherapy in combination with carfilzomib or pomalidomide, or who underwent stem cell transplant (STC) during index LOT were excluded. Monthly HRU and costs during index LOT were compared using inverse probability of treatment weights (IPTW) based on propensity scores for receipt of carfilzomib estimated by logistic regression with LOT, patient demographics, Charlson index, comorbidities, pre-index healthcare cost, and receipt of prior SCT as covariates.

Results: After weighting, baseline characteristics were well balanced among 114 carfilzomib and 144 pomalidomide patients. Mean (95% CI) numbers of outpatient visits per month were 7.1 (5.2–8.0) with carfilzomib and 4.7 (3.9–6.1) with pomalidomide (p = 0.006). Otherwise, there were no statistically significant differences between the groups in mean monthly HRU and costs or median time to therapy discontinuation. Mean (95% CI) monthly total healthcare costs were $19,776 (15,322–27,748) with pomalidomide and $17,321 (12,412–21,874) with carfilzomib (p = 0.522).

Limitations: Comparison of carfilzomib vs pomalidomide may be biased if there are unobserved factors not balanced by IPTW. The relatively small sample size limits the power of analyses to detect potential differences between treatment groups.

Conclusions: Monthly HRU and costs are similar among patients with relapse or refractory MM patients receiving carfilzomib or pomalidomide as monotherapy or in combination with dexamethasone.

Keywords:

• Carfilzomib
• healthcare costs
• HRU
• multiple myeloma
• pomalidomide

JEL CLASSIFICATION CODES:

• I10
• I19

Transparency

Declaration of funding

This study was sponsored by Amgen Inc.

Declaration of financial/other interests

MH is an employee of PAI and TED is a partner at PAI; AS was employed by PAI during the conduct of this study. PAI received funding from Amgen Inc. for study design, data programming, and analyses. SP is an employee of, and owns stock in, Amgen Inc. The peer reviewers on this manuscript have received an honorarium from JME for their review work. In addition, a JME peer reviewer has disclosed that they have received research funding from Takeda and Amgen; are a member of speaker’s bureaus for Takeda, Amgen, Celgene, Janssen, and BMS; and are a consult for PharmaMar. The authors and JME peer reviewers on this manuscript have no other relevant financial or other relationships apart from those disclosed.

Acknowledgements

None reported.

Previous peer-reviewed presentation

58^th ASH Annual meeting and exposition at San Diego, December 3–6, 2016.