Costs of sequential multiple myeloma treatment for elderly transplant-ineligible patients in the Serbian health care system

Abstract

Introduction. Multiple myeloma is an incurable plasma-cell pro?liferation mainly affecting the elderly population. The aim of this study was to analyze treatment patterns, utilization of health resources and treatment costs of multiple myeloma in the elderly patients ineligible for autologous hematopoietic stem cell transplantation in Serbia. Material and Methods. The analysis of the health?care costs, from the perspective of the Serbian healthcare system, took into account the costs of medications, diagnostic procedures, inpatient and outpatient care, as well as the costs of drug administration and management of drug adverse effects. Results. Thalidomide based regimens were less costly than bortezomib-based regimens (average per-protocol costs 6,000 ? vs. 64,700 ?, respectively). The most expensive treatment regimen was lenalidomide-dexamethasone (average per-protocol costs 145,200 ?). The sequential (four-line therapy) treatment costs varied from 85,800 ?, starting with melphalan-prednisone-thalidomide to 153,800 ?, starting with melphalan-prednisone-bortezomib. The estimated costs did not significantly differ during variation of the parameters in the sensitivity analysis. Conclusion. The costs of multiple myeloma treatment in the Republic of Serbia are mainly driven by the cost of antimyeloma drugs. The most expensive treatment sequence was starting with melpha1an-prednisone-bortezomib treatment protocol.