Cost-Effectiveness of Autologous Hematopoietic Stem Cell Transplantation for Elderly Patients with Multiple Myeloma using the Surveillance, Epidemiology, and End Results–Medicare Database

Abstract

In the past decade, the number of autologous hematopoietic stem cell transplants (Auto HSCT) for older patients with multiple myeloma (MM) has increased dramatically, as has the cost of transplantation. The cost-effectiveness of this modality in patients over age 65 is unclear. Using the Surveillance, Epidemiology, and End ResultseMedicare database to create a propensity-score matched sample of patients over age 65 between 2000 and 2007, we compared the survival and cost for those who received Auto HSCT to those who did not undergo transplantation but survived at least 6 months after diagnosis, and we calculated an incremental cost-effectiveness ratio (ICER). Two hundred seventy patients underwent transplantation. Median overall survival from diagnosis in those who underwent transplantation was significantly longer than in patients who did not (58 months versus 37 months, P < .001). For patients living longer than 2 years, the median monthly cost during the first year was significantly different, but the middle and last year of life costs were similar. The median cost of the first 100 days after transplantation was $60,000 (range, $37,000 to $85,000). The resultant ICER was $72,852 per life-year gained. Survival after transplantation was comparable to that in those who underwent transplantation patients under 65 years and significantly longer than older patients who did not undergo transplantation. With an ICER less than $100,000/life-year gained, Auto HSCT is cost-effective when compared with nontransplantation care in the era of novel agents and should be considered, where clinically indicated, for patients over the age of 65.

Utilization of novel systemic therapies for multiple myeloma: A retrospective study of front‐line regimens using the SEER‐Medicare data

“…Our results also indicate that IMiDs are increasingly used in a combination regimen with a PI. A previous study found a declining trend of treatment with IMiD‐only over time among patients who were diagnosed in 2007, 2008, and 2009 . The same study reported that IMiDs maintained a relatively stable share over the three cohorts (0.8% point decline) and we also found a relatively stable share over the same three cohorts (4.0% points).…”

Modified High-Dose Melphalan and Autologous Stem Cell Transplantation for Immunoglobulin Light Chain Amyloidosis

“…In contrast, patients treated with nontransplant therapies, such as proteasome inhibitors and immunomodulatory drugs, incurred costs of approximately 15,000 to 50,000 euros per line of treatment in a 2011 French study [21]. Another study of patients with multiple myeloma also showed that SCT was more cost-effective given the prolonged survival, even in patients over the age of 65 [22]. The study was based on data from the Surveillance, Epidemiology, and End Results-Medicare database and showed a median cost for the first 100 days after transplantation of $60,000 (range, $37,000 to $85,000).…”

Higher Stem Cell Dose Infusion after Intensive Chemotherapy Does Not Improve Symptom Burden in Older Patients with Multiple Myeloma and Amyloidosis

“…This would be particularly important for older MM patients who are increasingly undergoing ASCT [14] as a clinically- and cost-effective therapy [15, 16] and for patients with AL amyloidosis who also appear benefit from ASCT. [17] This study demonstrated the feasibility of prospectively collecting frequent longitudinal data on multiple symptoms in conjunction with longitudinal functional and immunological correlative data in the setting of an intense treatment such as ASCT.…”