Clinical outcomes and national information of patients with multiple myeloma (MM) covered under the largest national health insurance in a low-middle-income country.

Abstract

e18561 Background: In Colombia, national health insurance is private in all the country, with coverage greater than 95% of population. However, there is few health outcomes published in specific neoplastic diseases. We analyze relevant clinical outcomes and the information known by the largest health insurer Nueva EPS (NEPS) in a major region of Colombia, in patients with MM, which could allow decision-making in public health. Methods: Pts treated under the Valle del Cauca regional NEPS insurance with a diagnosis of MM between 1996 and 2018 and who received care at comprehensive cancer centers, were retrospectively identified. We collect relevant variables from the institutional electronic medical records and the information available from the insurer. Our primary objective was to determine the overall survival (OS) in general and specific populations and what was the important clinical information that could be extracted directly by the insurer to analyze and support decisions. We performed Kaplan Meier, and cox regression analysis with relevant variables. Results: 233 pts treated in 3 comprehensive cancer care centers in the city of Cali were included. Median overall survival was 68 months, with 25% alive at 15 years. Age > 75 years [HR 2.4, 95%CI 1.5-4, P = 0.0001], ISS category [HR 1.7, 95%CI 1.0-2.9, P = 0.003], and chronic kidney disease [HR 3.6, 95%CI 1.9- 6.7, P = 0.0004] were associated with a higher risk of death. Receiving an autologous transplant [HR 0.2, 95% CI 0.1-0.6, P = 0.0006] and the use of proteasome inhibitors and or immunomodulators were associated with better survival (OS 54 vs 15 months, p = 0.05). This contrasts with the scarce data available at the insurer, with information about heavy chain involved in only 63% of pts, light chain 44%, Durie-Salmon stage 54%, ISS stage 31%, FISH studies in 16%, type of 1st line of treatment in 65%, objective response 26% and overall survival in 72%. Conclusions: The survival of patients with MM treated under the largest health insurer in Colombia was good and similar to international series in highly experienced centers, however the relevant clinical information known by the insurer was poor. This supports the need to develop and have a single national electronic medical record that allows a better access to health data for decision-making in public health.