Racial Disparities in Treatment Patterns and Outcomes Among Patients with Multiple Myeloma: A SEER-Medicare Analysis

Abstract

Introduction: Recent advances in novel therapies and autologous stem cell transplants (ASCT) have increased treatment options for multiple myeloma (MM) and improved overall survival (OS). Previous studies suggest that racial disparities may exist in patient access to these treatments. The present study aimed to assess racial disparities in treatment patterns and clinical and economic outcomes among patients with MM. The study focused on the comparison between Caucasians (CAU) vs African Americans (AA) and Hispanics (HISP). Other racial/ethnic groups were not included due to small sample size. Methods: Patients with a confirmed MM diagnosis (dx) from the SEER-Medicare (2007-2013) database were included. Continuous enrollment for six months before (baseline) and at least six months after the initial MM dx date was required, unless the patient died prior to that. Treatment patterns (including time from initial MM dx to first-line (1L) therapy initiation, novel therapy [i.e., lenalidomide, pomalidomide, bortezomib, carfilzomib] initiation, and ASCT), time to first hospitalization or emergency department (ED) admission after MM dx, and healthcare costs (up to one year after MM dx), OS, and MM-specific survival (MSS) among the three racial/ethnic cohorts were evaluated. Unadjusted statistical comparisons were conducted for AA vs CAU and HISP vs CAU. In addition, multivariable regression models were used to adjust for baseline characteristics, including age, gender, marital status, region, poverty indicator, MM dx year, select comorbidities, and baseline healthcare costs. Trends in novel treatment utilization and OS across MM dx years were assessed using linear regression models. Results: The study included 4,830 patients (3,504 CAU, 858 AA, and 468 HISP). CAU were significantly older (mean age 76 years) than AA (72) and HISP (73). The average follow-up time was 2.2 years. Median time from MM dx to 1L therapy initiation was significantly longer for AA compared to CAU (1.9 vs 1.5 months, p In terms of resource utilization, AA had a significantly higher risk of ED admission compared to CAU (3-month ED admission rate: 31.2% [AA], 23.8% [CAU]; adjusted HR = 1.2, p Conclusions: Significant variations in terms of treatment patterns and outcomes were observed among different racial/ethnic groups. While OS was similar across cohorts, both AA and HISP may not be reaping the full benefits from the introduction of novel therapies, as they receive them later than CAU. Use of novel therapy increased over time, but the increase was more pronounced in CAU than AA. Healthcare costs were similar between AA and CAU, while HISP had higher total costs than CAU, mainly driven by higher hospitalization costs. These disparities must be addressed for equitable healthcare utilization and universal benefit. Disclosures Ailawadhi: Takeda: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Pharmacyclics: Research Funding; Novartis: Consultancy, Honoraria. Parikh: Celgene Corporation: Employment. Zhou: Analysis Group, Inc.: Employment; Celgene Corporation: Other: I am an employee of Analysis Group, which received consulting fees from Celgene for this study. Tang: Analysis Group, Inc.: Employment; Celgene Corporation: Other: I am an employee of Analysis Group, which received consulting fees from Celgene for this study. Clancy: Celgene Corporation: Employment. Cheung: Analysis Group, Inc.: Employment; Celgene Corporation: Other: I am an employee of Analysis Group, which received consulting fees from Celgene for this study. Zhou: Analysis Group, Inc.: Employment; Celgene Corporation: Other: I am an employee of Analysis Group, which received consulting fees from Celgene for this study. Xie: Analysis Group, Inc.: Employment; Celgene Corporation: Other: I am an employee of Analysis Group, which received consulting fees from Celgene for this study. Abouzaid: Celgene Corporation: Employment, Equity Ownership, Research Funding.