Healthcare Resource Use and Costs Among Patients (pts) with Relapsed/Refractory Multiple Myeloma (RRMM)

Background

Few studies have assessed HRU and costs in RRMM.  A prior study reported 1-yr total healthcare costs of $113,000 (2013 US $) among non-transplant patients with newly diagnosed MM (DaCosta Byfield ASCO 2015).  Real-world data on economic burden in the era of new MM therapeutic options could provide insight for directing efficient resource utilization.  We examined HRU and costs associated with second-line therapy (SLT) in RRMM.

Methods

We identified adult pts with MM between Jan 2008 and Feb 2014 in a large, national, healthcare claims database of commercially insured and Medicare Advantage beneficiaries.  Newly diagnosed pts were followed from first claim for MM (+12-mo wash out period).  Pts with continuous enrollment from 12 mos pre-diagnosis through 12 mos post-initiation of SLT for RRMM were included (including pts who died within 12 mos post SLT start).  Those with a claim for transplants were excluded.  Front-line therapy (FLT) began with the first claim for MM-directed systemic cancer therapy.  Unique agents administered within 90 d of FLT initiation constituted a regimen.  Continuation of FLT regimen (or part thereof) or monotherapy within 3 mos of the end of the initial regimen was considered part of FLT.  SLT after first relapse for RRMM was identified accordingly: 1) a treatment gap >6 mos between end of FLT and start of a 2^ndregimen (retreatment or switch), 2) start of a follow-up regimen (retreatment) with treatment gap >3 and ≤6 mos after end of FLT, or 3) a switch to another drug combination after FLT.  The first claim for SLT was the index date.  Healthcare costs and HRU were determined for the 1-yr period following SLT start.  Healthcare costs were calculated as total reimbursed amount to the provider paid by the health plan, the pt, and other payers, including treatment with subsequent lines of therapy if falling within the 1-yr period.  Drug and drug-administration costs were captured from a) all pharmacy claims for MM-directed systemic therapy, and b) medical claims with CPT codes indicating chemotherapy drug administration if, on the same date of service, there was a claim with a HCPCS for any drug of interest.

Results

We identified 160 of 249 pts receiving SLT.  The majority (55%) were female, 72% were aged ≥65 yrs, 10% received triplet SLT, and 53% were enrolled in a Medicare Advantage plan.  Most common SLT regimens were bortezomib- (39%) or lenalidomide-based (38%) (Table 1).

RRMM pts averaged 58 ambulatory visits and 1.2 hospitalizations in the yr following start of SLT, with 5.1 ICU and 7.9 non-ICU days.  Mean 1-yr healthcare costs were $123,922 with 59% of total costs attributable to non-drug costs (mean: $72,718; Table 2). 

Conclusions

The healthcare and economic burden of illness among pts with RRMM receiving SLT is substantial.  The main cost driver in RRMM was non-drug related. While this research did not examine indirect costs, rates of ambulatory visits and hospitalization days occurring within 1 yr of the start of SLT were high and likely correlated with indirect costs to both the pt and caregiver.  New treatment options with a more favorable side-effect and efficacy profile may mitigate this burden. At study completion, a statistical analysis will be conducted to assess the determinants and drivers of economic burden in RRMM.

Table 1.  RRMM pt Characteristics and SLT patterns

	Total (N=160) n (%)*
Died during 1-yr following start of SLT	36 (22.5)
Age, yrs
<65	45 (28.1)
65-74	45 (28.1)
≥75	70 (43.8)
Male	72 (45)
Insurance type
Commercial	76 (47.5)
Medicare Advantage	84 (52.5)
SLT regimens
Bortezomib-based	62 (38.8)
IMiD-based	60 (37.5)
Bortezomib + IMiD	3 (1.9)
Other†	35 (21.9)
Start of a new regimen within 1 yr (3rd line)	68 (42.5)

*unless otherwise noted ^†including cyclophosphamide, melphalan, vincristine, doxorubicin, interferon-alpha, pomalidomide, thalidomide, carfilzomib, dexamethasone, prednisone ^‡among non-censored pts

Table 2. Healthcare costs and encounters among pts with RRMM after initiation of SLT

1-yr healthcare costs (2014 US$)	Mean (SD) (N=160)
Total	123,922 (114,052)
Drug	51,204 (40,997)
Non-drug	72,718 (102,169)
Total	123,922 (114,052)
During SLT	81,590 (90,151)
After 3rd Line initiation*	33,573 (64,832)
SLT end to start of 3rd Line	8,759 (28,046)
Healthcare encounters per pt
Ambulatory visits	58.5 (32.6)
ER visits	1.7 (2.2)
Hospitalizations	1.2 (1.7)
Inpatient length of stay, days	13.0 (26.6)
Non-ICU	7.9 (21)
ICU	5.1 (12.7)

*censored at 12 mos after SLT initiation