To better understand the real-world impacts of the advances in treatment for multiple myeloma (MM) over the past 15 years, Safiya Abouzaid, PharmD, Celgene Corporation in Summit, NJ, and colleagues sought to describe trends in novel therapy use, total healthcare costs, and survival outcomes among patients newly diagnosed with MM in the United States since 2000. They presented their findings on Sunday, December 4, at the 58th American Society of Hematology Annual Meeting and Exposition in San Diego, CA.

The authors used the Truven Health MarketScan Research Databases to identify 19,417 patients newly diagnosed with MM, aged 18 and older, who had two or more MM medical claims at least 30 days apart between January 2000 and September 2015. The first medical claim date for MM was designated as the index date. Participants were included if they had 12-month pre-index and three-month post-index uninterrupted enrollment. Study authors selected controls from a group of patients without MM and matched them 1:1 with patients with MM based on index year, age, gender, and geographic region; 18,260 patients were matched to controls. Death events were included in the survival outcomes analysis if the data could be collected from the Social Security Administrations Master Death File; survival time was measured as time from index date to the date of death.

In considering healthcare costs, researches considered the total of health plan and patient paid costs for prescriptions and medical services, together with inpatient admissions, emergency room and physician office visits, and other outpatient services. MM treatment-related drug costs involved outpatient pharmacy prescription costs and costs from outpatient services for infused therapies. 

Several key trends emerged.

  • The use of novel therapies by patients with MM increased from 8.7% in 2000 to 61.3% in 2014. 
  • Overall, over the study period, 28% of patients with MM didn’t receive any treatment within one year after diagnosis.
  • Total per-patient-per-month (PPPM) all-cause healthcare costs rose from $3,263 in 2000 to $14,656 in 2014 among patients newly diagnosed MM, caused mainly by outpatient services (see Figure 1).
  • Hospitalization costs were 21.5% of total costs in 2000 and 32.7% in 2014. 
  • MM treatment-related drug costs comprised 10.6% of total costs in 2000, 23.6% in 2009, and 28.5% in 2014.  

Patients diagnosed more recently tended to use novel therapies more and had significantly better survival outcomes (see Figure 2); for example, patients diagnosed in 2012 were 1.25 times more likely to live two years longer than patients diagnosed in 2006.

“Findings from this study corroborate clinical data suggesting a paradigm shift in MM treatment over the past 15 years that is associated with substantial survival gains,” Abouzaid said. “Future studies should focus on the impact of specific novel agents on patient survival, the value of clinical benefit engendered, and overall healthcare costs to better inform decision-making in this setting.”