Real-world drug regimes for multiple myeloma in a Swiss population (2012 to 2017) : cost-outcome description

Abstract

Abstract Background Novel drugs are dynamically changing current treatment regimens for multiple myeloma (MM). Novel drugs have improved prognosis of MM patients in clinical studies but are expensive. Little is known about up-to-date real-world application and costs. Methods We performed a retrospective observational cohort analysis (cost-outcome description; 2012-2017) in a claims database of a major Swiss health insurance company which covers 14% of the Swiss population (Helsana Versicherungen AG).We used primary (MM diagnoses via ICD-10) and secondary features (prescribed MM-specific drugs) as inclusion criteria and defined a hierarchy of drug regimens to classify treatments as: 1) proteasome inhibitor (PI)-based regimen (e.g. bortezomib); 2) IMID-based regimen (e.g. lenalidomide); 3) chemotherapy (CHEMO)-based regimen (e.g. bendamustin); 4) monoclonal antibody (MAB)-based regimen (e.g. daratunumab). Direct medical costs of mandatory health insurance were analysed in 2017 Swiss Francs (CHF; third party payer perspective). Results Overall, we identified n=1054 prevalent MM patients (2012-2017) and n=378 incident MM patients (2015-2017; men: 47.1%; age group PI-based regimens were the most frequent first line approach for incident patients (76.0%), followed by IMID-based (21.9%) and CHEMO-based regimens (2.1%). Only four patients were treated with MAB-drugs. For later lines, IMID-based regimens were most often used (2nd line: 56.4%; 3rd line: 2 of 3 patients), followed by PI-based regimens (43.6% and 1 of 3 patients, respectively). 161 of 1054 prevalent MM patients (15.3%) were treated with autologous hematopoietic stem cell transplantation (HSCT), 4 patients with allogeneic HSCT. Average costs per patient per treatment line varied considerably (reliable data available from 2012 to 2014; mean duration of lines between 112 and 388 days): PI-based regimens: CHF 81’352; IMID-based: CHF 73’495; CHEMO-based: CHF 683. Mean daily costs under MM treatment stepwise increased from CHF 209 in 2012 to CHF 254 in 2017 (relative increase: 21.5%). Annual direct medical costs in Switzerland for seven novel MM drugs were extrapolated to be 60.1 Mio CHF in 2012 and 118.6 Mio CHF in 2017 (relative increase: 97.3%), corresponding to mean annual outpatient MM drug costs per patient of CHF 28’000 in 2017. Annual death rates decreased systematically from 18.6% in 2012 to 15.5% in 2017 (p for trend: 0.03). No statistically significant difference in death rates emerged for 2017 compared with 2012 (risk ratio: 0.83; 95%-CI: 0.63 to 1.10; absolute risk reduction: 3.1%). Conclusions Current treatment patterns for MM patients in Switzerland show variation concerning applied drug regimens as well as costs. An increasing prevalent population of MM patients in combination with increasing costs per day under treatment lead to a substantial and growing budget impact for the Swiss social insurance system.