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Abstract
Double relapsed and/or refractory multiple myeloma (DRMM), MM that is relapsed and/or refractory to bortezomib and lenalidomide, carries a poor prognosis. The healthcare costs of DRMM have not previously been reported. We analyzed detailed medical resource utilization (MRU) costs, drug costs and outcomes for 39 UK patients receiving standard DRMM therapy. Median OS in this cohort was 5.6 months. The mean cost of DRMM treatment plus MRU until death was £23,472 [range: £1,411–£90,262], split between drug costs £11,191 and other resource use costs £12,281. The cost per assumed quality-adjusted life year (QALY) during DRMM was £66,983. These data provide a standard of care comparison when evaluating the cost-effectiveness of new drugs in DRMM.
Highlights
Patients with treatment-refractory malignancy have poor outcomes and high healthcare costs
Retreatment with bortezomib (15.4%) or lenalidomide (33.3%) based regimens was used if poor bone marrow reserve precluded bendamustine use and suitable clinical trial alternatives were lacking
Two patients who had not previously received bortezomib due to neuropathy did receive it at Double relapsed and/or refractory multiple myeloma (DRMM) with no recorded worsening of neuropathy; one had progressive disease despite its use and the other had a partial response of 6 months duration
Summary
Patients with treatment-refractory malignancy have poor outcomes and high healthcare costs. In Multiple Myeloma (MM), the introduction of the proteasome inhibitor bortezomib and immunomodulatory drugs (IMiDs) thalidomide and lenalidomide has improved survival over the last decade [1], but increased the cost of treatment While these drugs can result in remission, most patients will relapse with increasing symptom burden and worsening prognosis [2]. An IMWG retrospective analysis of patients who relapsed following bortezomib and at least one of the IMiDs showed a median overall survival (OS) and progression-free survival (PFS) of 9 months and 5 months respectively [4]. Those potentially eligible for further clinical trials with Eastern Cooperative Oncology Group Performance Status
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