The relationship between cost and the recommendation, refusal, and discontinuation of treatment for chronic myeloid leukemia and multiple myeloma in Japan: a cross-sectional exploratory survey

Abstract

Aims

This study aimed to ascertain the number of patients with chronic myelogenous leukemia (CML) and transplant-ineligible patients with multiple myeloma (MM) not recommended by their physicians for optimal drug treatment or who refuse, discontinue, reduce, or skip treatment owing to cost in Japan.

Methods

A cross-sectional survey was conducted among hematologists, hematologic oncologists, and oncologists in Japan treating ≥1 patient with CML or ≥5 transplant-ineligible patients with MM per year.

Results

A total of 212 physicians participated: 105 treating patients with CML and 107 treating transplant-ineligible patients with MM. While treatment cost did not lead to non-optimal treatment most patients, physicians reported that they recommended non-optimal treatment to 6.53% of their patients with CML and 1.41% of their transplant-ineligible patients with MM, that 1.51 and 0.35% of their patients, respectively, refused treatment and that 1.97 and 0.71% discontinued treatment owing to treatment cost. However, no significant differences in the effect of treatment cost on recommendation, discontinuation, refusal, or reduction of treatment were observed. Non-recommendation of optimal treatment owing to treatment cost was most common for third-line CML and fourth-line transplant-ineligible MM treatment. Discontinuation due to treatment cost was most common in third-line treatment for both.

Conclusion

Our results show that non-optimal treatment due to treatment cost occurs among some physicians in Japan for patients with CML and transplant-ineligible patients with MM, but it may be limited to a small percentage of patients. Further research is needed to identify the drivers of treatment decisions for physicians and patients, including those involving treatment cost.

Keywords:

• Hematology
• health economics
• treatment cost
• treatment decisions
• Japan

JEL CLASSIFICATION Codes:

• I12
• I1
• I
• I19

Transparency

Declaration of funding

The article received funding from AbbVie GK.

Declaration of financial/other relationships

TMi is a full-time employee of AbbVie GK. TMu, YH, and JS are former employees of AbbVie GK. NT and ML are full-time employees of INTAGE Healthcare Inc.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

TMu, YH, TMi, NT, ML, and JS were involved in the overall conceptualization of the study. TMu, NT, and ML were involved in the design of the questionnaire. NT managed the data collection process. NT and ML analyzed the data with support from TMu. ML and NT were involved in the interpretation of results and the initial drafting of the manuscript. TMu, YH, TMi, and JS reviewed the draft manuscript and provided suggestions to improve it. ML and NT finalized the manuscript.

Acknowledgements

We would like to thank Yukiko Nishimura for her advice and input on the concept of this study and Kazutake Yoshizawa, and Masahiko Nakayama for their advice and input on the study design. We also thank Yoko Yajima and Natsuko Satomi for their advice and input regarding the survey instrument development. This study was funded by AbbVie GK.