Abstract
BackgroundHigh-dose therapy with autologous peripheral stem cell transplantation represents today the standard approach for younger multiple myeloma patients. This study aimed to evaluate the long term economic impact of autologous transplantation with respect to conventional therapy.MethodsWe retrospectively reviewed the charts of multiple myeloma patients diagnosed at our department between 1986 and 2003 and treated according to the therapy considered standard at the time of diagnosis. Analysis of costs was done by assessing resource utilization and direct costs were measured and monetized before proceeding with the analysis, based on public health service tariffs.ResultsGroup A including 78 patients treated with Melphalan and Prednisone was compared with Group B including 74 patients who received an autologous transplant. The median overall survival was 3.2 and 5.4 years respectively (p = 0.0002). Mean cost per patient was significantly higher in group B with respect to group A (102373€ vs 23825€; p<0.001). The final quality-adjusted-life-year gain in group B patients as compared to group A was 1.73 QALY, with an incremental cost-effectiveness ratio of 45460€. With a threshold of 75000€ per QALY gained, the cost effectiveness acceptability curve indicated that the probability that autologous transplantation in multiple myeloma is a cost-effective intervention is 90%.ConclusionsThe cost of autologous transplantation remains high. The calculated incremental cost-effectiveness ratio, however, given the significant prolongation of overall survival obtained with autologous transplantation, is within an acceptable threshold. Notwithstanding, its high cost should be taken into account when considering the whole cost of multiple myeloma.
Highlights
Multiple myeloma (MM) is a progressive hematologic malignancy accounting for approximately 0.8% of all cancer diagnoses and 0.9% of all cancer deaths worldwide [1]
At the beginning of the 90’s, two meta analyses [2,3] of subsequent randomized trials, assessing more than 6000 patients, showed that outcomes are similar in patients treated with melphalan and prednisone or combination chemotherapy
The use of high-dose chemotherapy with stem cell support has clearly improved disease-free survival and has increased overall survival of at least 24 months compared to the standard conventional chemotherapy Melphalan and prednisone (MP) regimen
Summary
Multiple myeloma (MM) is a progressive hematologic malignancy accounting for approximately 0.8% of all cancer diagnoses and 0.9% of all cancer deaths worldwide [1]. During 1998–2002, it represented approximately 1.2% of all the cancers and 1.7% of all the cancer deaths in Italy. Multiple myeloma is still a non-curable plasma cell neoplasm. Melphalan and prednisone (MP) has represented the backbone of therapy for more than 30 years in all settings of patients. The use of high-dose chemotherapy with stem cell support has clearly improved disease-free survival and has increased overall survival of at least 24 months compared to the standard conventional chemotherapy MP regimen. High-dose therapy with autologous peripheral stem cell transplantation represents today the standard approach for younger multiple myeloma patients. This study aimed to evaluate the long term economic impact of autologous transplantation with respect to conventional therapy
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