Costs of sequential multiple myeloma treatment for elderly transplant-ineligible patients in the Serbian health care system

Abstract

Multiple myeloma (MM) is an incurable malignant plasma-cell proliferation manifesting with bone pain, hypercalcemia, anemia, renal insufficiency and malaise [1]. It accounts for approximately 10% of all hematologic malignancies worldwide and it commonly affects the elderly population, and the median age at diagnosis is between 65 and 70 years [2]. The incidence of hematologic malignancies is remarkably lower in Eastern European coun-88 Summary Introduction. Multiple myeloma is an incurable plasma-cell proliferation mainly affecting the elderly population. The aim of this study was to analyze treatment patterns, utilization of health resources and treatment costs of multiple myeloma in the elderly patients ineligible for autologous hematopoietic stem cell transplantation in Serbia. Material and Methods. The analysis of the healthcare costs, from the perspective of the Serbian healthcare system, took into account the costs of medications, diagnostic procedures, inpatient and outpatient care, as well as the costs of drug administration and management of drug adverse effects. Results. Thalidomide based regimens were less costly than bortezomib-based regimens (average per-protocol costs 6,000 € vs. 64,700 €, respectively). The most expensive treatment regimen was lenalidomidedexamethasone (average per-protocol costs 145,200 €). The sequential (four-line therapy) treatment costs varied from 85,800 €, starting with melphalan-prednisone-thalidomide to 153,800 €, starting with melphalan-prednisone-bortezomib. The estimated costs did not significantly differ during variation of the parameters in the sensitivity analysis. Conclusion. The costs of multiple myeloma treatment in the Republic of Serbia are mainly driven by the cost of anti-myeloma drugs. The most expensive treatment sequence was starting with melpha1an-prednisone-bortezomib treatment protocol.

Construction of a Digital Elderly Care Service System Based on Human-Computer Interaction from the Perspective of Smart Elderly Care

“…In order to cope with the increasingly serious aging problem and the growing demand for elderly care, the elderly care services provided by community service centers must meet the needs of the elderly; social organizations and volunteers for the elderly are encouraged. Design and construction departments should design and arrange living facilities and activity venues suitable for the elderly when building urban and rural public facilities and residential areas [21]. In July 2001, a city launched the "Starlight Plan for Community Elderly Care Services" to provide the elderly with functions such as day care services, nursing, health rehabilitation, sports and leisure, home services, and emergency assistance.…”

Long-Term Effectiveness and Cost Effectiveness of Multiple Myeloma Treatment Strategies for Elderly Transplant-Ineligible Patients in Serbia

“…A bottom-up micro-costing method was applied to analyze healthcare resource consumption and associated costs ( 39 ). Healthcare resource utilization during MM treatment was estimated based on the national guideline ( 18 ) and clinical experts’ estimates.…”

“…The unit costs of drug acquisition, diagnostic procedures, hospitalization, outpatient care, and injectable drug administration were extracted from the National Health Insurance Fund (NHIF) databases ( 40 , 41 , 42 ) and converted to 2018 euros based on purchasing power parities (1 euro=56.3 Serbian dinars) ( 43 ). Details on unit costs and cost calculation can be found elsewhere ( 39 ).…”