PCN101 - COSTS AND HEALTHCARE RESOURCE USE ASSOCIATED WITH MAINTENANCE THERAPY IN MULTIPLE MYELOMA: A SYSTEMATIC LITERATURE REVIEW

Abstract

Maintenance therapy (MT) improves clinical outcomes in multiple myeloma (MM), yet the economic impact of MT is unclear. We summarized published evidence on costs and healthcare resource use (HCRU) associated with MT for MM. A systematic literature review was conducted, searching MEDLINE, EMBASE, NHS-EED, EconLit from 2008 to March 2018 and seven conference proceedings from 2015-2018. HCRU and costs were abstracted. Five studies reported HCRU or direct costs of MT vs. no MT. No indirect costs were reported. Of these five studies, four examined lenalidomide MT and one included any MT. In one study, numerically shorter duration and lower rates of hospitalization were noted at one and two years post-stem cell transplant (SCT) with MT vs. no MT; use of procedures/surgeries and concomitant medications were similar across these MT groups. One study indicated that post-SCT MT defers progression, decreasing overall monthly costs related to hospitalizations, doctor visits, and monitoring tests. Similarly, another study in post-SCT patients reported significantly lower outpatient costs and numerically lower inpatient costs for MT vs. no MT patients. One study reported 24% less direct medical costs at five years post-SCT with MT vs. no MT. In transplant-ineligible patients for the first 36 months of treatment, a cost-effectiveness analysis of the MM-015 trial reported higher average cumulative cost (ACC) per patient with MT vs. no MT; however, with a longer follow-up that included the entire progression-free survival period, the ACC was lower for MT. This review suggests that MT does not increase HCRU and may lead to lower direct medical costs in post-SCT MM patients and in SCT-ineligible patients with longer follow-up when efficacy of MT is accounted for. Overall, data on HCRU and costs associated with MT are limited, primarily examining lenalidomide MT. This review underscores the need for further assessments.