Preventing Relapse in Myeloma Carries Economic Benefits, Reduces Overall Costs

Dana Taylor

March 2015, Vol 6, No 2 - Economics of Cancer Care

San Francisco, CA—In what is believed to be the first economic analysis of disease progression of patients with myeloma, researchers found that in patients with newly diagnosed myeloma, the monthly costs are reduced by 68% between the first 4 months through 18 months, but they then rise steeply when the disease relapses. The data were presented at the 2014 American Society of Hematology meeting.

“Few studies have examined the cost patterns of newly diagnosed patients before and after their first relapse, particularly using real-world data,” said Gary Binder, of Celgene Corporation. “We know about the consequences of disease progression from a clinical perspective, but to our knowledge there’s never been an analysis of what this means from an economic perspective,” he said. “We wanted to examine the patterns of cost in the first-line setting, and see how those compared to the second line setting.”

Treatment with bortezomib and lenalidomide, and longer durations of treatment, have prolonged survival in ­patients with myeloma, but this improvement has raised interest in the cost of treating newly diagnosed patients. An economic analysis could be valuable in informing decisions on the cost-effectiveness and economic benefits of long-term drug therapy for patients with myeloma, including the economic impact of extending time to disease progression and the cost consequences when the disease relapses and the patient moves to second-line therapies.

Mr Binder and his colleagues, in collaboration with the Levine Cancer Institute and the Carolinas HealthCare System in Charlotte, NC, examined a US database sourced from employer-sponsored health insurance plans and Medicare and Medicaid, covering more than 25 million lives annually. Their analysis included 897 patients newly diagnosed with myeloma and 280 patients with relapsed myeloma who received lenalidomide-based or bortezomib-based regimens between 2006 and 2012.

Cost Spikes with Relapsed Disease

“We found that over time, the cost per month per patient declined, then started to plateau out at 18 months. When patients relapsed and went on second-line treatment, the cost spiked again, then declined but never to the same level,” Mr Binder pointed out.

The mean monthly total direct costs (medical and pharmacy-related costs combined) were $15,000 during the first 3 months of treatment and declined each quarter to $4927 monthly at 18 months after starting treatment. At disease relapse, the monthly costs increased to more than $12,000 for the first 3 months and followed a quarterly pattern of reduction, similar to that seen for newly diagnosed patients but never reaching the same low level. The mean cost stabilized at $5345 after second-line treatment.

By drug, the total monthly cost of treating a newly diagnosed patient averaged $8941 with lenalidomide and $11,139 with bortezomib. For relapsed patients, the mean total costs were $8859 and $10,063, respectively.

The quarterly cost-reduction patterns were consistent for lenalidomide and for bortezomib in newly diagnosed patients (first-line setting) as well as relapsed patients (second-line setting).

“The findings suggest that the longer you can sustain a patient in first-line status, the longer the patient will be running at below-average cost. Preventing relapses saves money,” Mr Binder said in an interview.