Abstract
Multiple myeloma (MM) is one of the most prevalent hematologic cancers. Treatments of MM have been improved by availability of novel therapies but require regular hospital visits and intense patient follow-up. In this real-world study, patient characteristics, first four treatment lines (1L–4L), and associated outcomes and costs were assessed among adults treated for active MM during 2009–2016 at Kymenlaakso Central Hospital, Kymsote hospital district, Finland. In addition, patient burden and travel costs were determined for the patients treated during 2015–2016. Ninety-seven patients fulfilled the inclusion criteria. Data were retrospectively collected from hospital’s database, medical charts, and from healthcare professionals. Treatment lines and responses were defined according to the general recommendations. The median age at diagnosis was 70.1 years. The median overall survival was 68 months. Proteasome inhibitors (PI) or immunomodulatory drugs (IM) were the most common regimen types while the utilisation of a more novel approach, the simultaneous use of PI and IM, was low across first four treatment lines. Overall response rate was 72–74% for 1L–2L and 50–56% for 3L–4L. Drug costs represented the greatest proportion of total healthcare costs and increased in the later treatment lines. Patients receiving infusion treatments had specialised health care visits twice as much the patients treated with oral treatments. Furthermore, travel costs related to infusion treatments were three to four times more compared to the respective costs for oral treatments. Increasing drug costs but poorer treatment outcomes in later treatment lines underline a need for more efficient and better tolerated treatment options. This study demonstrates that oral treatments may indeed reduce patient and hospital resource burden and thus, should be considered in future health economic evaluations in Finland.
Highlights
Multiple myeloma (MM, International Classification of Diseases 10th Revision, ICD-10, diagnosis code C90.0) is a B cell/plasma cell malignancy resulting from a complex series of mutations and clonal selection events that lead to the clonally heterogenous neoplasm of B cells in the bone marrow and overproduction of monoclonal immunoglobulins often causing organ/tissue damage [1, 2]
During 2009–2016, ninety-nine MM patients were treated at Kymenlaakso Central Hospital, Kymsote
The average population size at Kymsote during the study period was 173 693 inhabitants and the respective calculated unadjusted incidence for patients treated for active multiple myeloma at Kymsote was 7.1/100 000/year
Summary
Multiple myeloma (MM, International Classification of Diseases 10th Revision, ICD-10, diagnosis code C90.0) is a B cell/plasma cell malignancy resulting from a complex series of mutations and clonal selection events that lead to the clonally heterogenous neoplasm of B cells in the bone marrow and overproduction of monoclonal immunoglobulins often causing organ/tissue damage [1, 2]. MM is one of the most prevalent hematologic cancers, and the most common plasma cell cancer type [4,5,6]. It is more often diagnosed in men and in elderly patients with a median age of diagnosis being 65–70 years [4, 6,7,8]. According to the available national literature and Finnish Cancer Registry data on myeloma and plasma cell cancers, around 300–400 new myeloma cases are diagnosed annually in Finland (1% of all cancers) with the unadjusted incidence being 5–7/100 000/year (the age-adjusted incidence around 3/100 000/year) [6, 11,12,13]
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