Multiple Myeloma Treatments, Outcomes, and Costs of Health Care Resource Utilisation During 2009-2016, Based on Multiple Data Sources from a Hospital District in Finland

Abstract

Multiple myeloma (MM) is one of the most prevalent hematologic cancers. Treatments of MM have been improved by availability of novel therapies but require regular hospital visits and intense patient follow-up. In this real-world study, patient characteristics, first four treatment lines (1L-4L), and associated outcomes and costs were assessed among adults treated for active MM during 2009-2016 at Kymenlaakso Central Hospital, Kymsote hospital district, Finland. In addition, patient burden and travel costs were determined for the patients treated during 2015-2016. Ninety-seven patients fulfilled the inclusion criteria. Data were retrospectively collected from hospital's database, medical charts, and from healthcare professionals. Treatment lines and responses were defined according to the general recommendations. The median age at diagnosis was 70.1 years. The median overall survival was 68 months. Proteasome inhibitors (PI) or immunomodulatory drugs (IM) were the most common regimen types while the utilisation of a more novel approach, the simultaneous use of PI and IM, was low across first four treatment lines. Overall response rate was 72-74% for 1L-2L and 50-56% for 3L-4L. Drug costs represented the greatest proportion of total healthcare costs and increased in the later treatment lines. Patients receiving infusion treatments had specialised health care visits twice as much the patients treated with oral treatments. Furthermore, travel costs related to infusion treatments were three to four times more compared to the respective costs for oral treatments. Increasing drug costs but poorer treatment outcomes in later treatment lines underline a need for more efficient and better tolerated treatment options. This study demonstrates that oral treatments may indeed reduce patient and hospital resource burden and thus, should be considered in future health economic evaluations in Finland.

Real‐world experience of novel multiple myeloma treatments in a large, single‐center cohort in Finland

“…The patient characteristics of the overall study cohort reflect previous findings from Finland and other European countries with the median age at diagnosis being around 70 years and a slightly higher proportion of patients being male [2,[22][23][24][25][26][27]. In this study, carfilzomibbased regimens were the most used among the most novel regimens.…”

“…The data used in retrospective studies reflect the everyday clinical coding practices and thus may be nonstandardized and incomplete. In addition, the rapidly changing treatment landscape and varying coding practices challenge the identification of individual treatment lines, as discussed in connection with earlier studies using similar data sources [2, 22, 23]. Despite these issues, we were able to determine the IMWG risk group and ORR for a subset of patients, which has previously proven to be a challenge in studies utilizing Finnish real‐world data.…”

“…The comparison of treatment patterns in different populations is difficult for several reasons, for example, the choice of treatment has to be considered with respect to local treatment recommendations and changes in local reimbursement policies [10, 23]. Earlier reports from Europe have shown that most patients receive bortezomib‐based regimens in 1L, whereas lenalidomide has been the most commonly used agent in 2L.…”

“…In the European real‐world cohort, the majority of KRd patients were in the first relapse, and more than 50% of patients receiving Kd had at least three prior lines of therapy [28, 30]. In a Finnish RWE study reporting clinical practice between 2005 and 2016, KRd was used from 3L onward in up to 5% of the patients [23]. Taken together, our study showed that the use of the most novel therapies was very limited in Finland between 2016 and 2020.…”

“…Several observational studies from Finland on MM capturing data until 2016 have been previously published [2,22,23]. This study included patients treated with therapies considered as novel during the study period (2016-2020).…”