Patterns of total cost and economic consequences of progression for patients with newly diagnosed multiple myeloma

Arikian, Steven R.; Milentijevic, Dejan; Binder, G.; Gibson, Craig J.; Hu, Xiaobei; Nagarwala, Yasir M.; Hussein, Mohamad A.; Corvino, Frank A.; Surinach, Andy; Usmani, Saad Z.

doi:10.1185/03007995.2015.1031732

Cited by 33 publications

(39 citation statements)

References 24 publications

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“…Our findings agree with those from Arikian et al, who used US healthcare data to show that, for the first 3 years of treatment, patients who initiated lenalidomide-based treatments had lower mean monthly total costs compared to those who initiated on bortezomib-based treatments [8]. Arikian et al also demonstrated that the cumulative cost of first-line lenalidomide was approximately $120,000 (€109,000) lower than for first-line bortezomib [8].…”

Section: Discussionsupporting

confidence: 92%

“…Arikian et al also demonstrated that the cumulative cost of first-line lenalidomide was approximately $120,000 (€109,000) lower than for first-line bortezomib [8]. These findings further support our recommendation that the most beneficial way to use lenalidomide for patients with newly diagnosed multiple myeloma is at first-line thus capitalising on its increased time to progression/OS and cost impact compared to other choices of first-line treatment.…”

Section: Discussionsupporting

confidence: 68%

“…The increased survival benefit with lenalidomide was confirmed by Weisel et al, who conducted a network meta-analysis of survival in randomised controlled myeloma trials; lenalidomide was associated with a significant progression-free and overall survival advantage versus other first-line treatments (bortezomib, melphalan, and prednisone [VMP] and MPT) [7]. In addition to its favourable efficacy and acceptable toxicity profile, lenalidomide is an oral therapy requiring fewer hospital visits for treatment administration compared with alternative subcutaneous or intravenous agents [8–10], making this a more acceptable and better tolerated class of drugs.…”

Section: Introductionmentioning

confidence: 99%

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The Cost Impact of Lenalidomide for Newly Diagnosed Multiple Myeloma in the EU5

et al. 2017

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IntroductionLenalidomide is an active agent that was approved for use in the EU in 2015 as a first-line therapy for previously untreated, non-transplant eligible multiple myeloma patients. Our objective was to assess the cost impact of lenalidomide when selected as a first-line treatment for transplant-ineligible patients in France, Germany, Italy, Spain, and the United Kingdom (EU5).MethodsWe developed a cost-impact model of the total costs associated with newly diagnosed multiple myeloma over 5 years in the EU5 based on treatment duration and time to progression (TTP) (taken from trial data). We compared a baseline scenario (of current lenalidomide uptake) with two alternative future scenarios. Future Scenario A used an increased uptake of first-line lenalidomide: up to 50% in Year 5. Future Scenario B was similar to the baseline, but included a 20% increased uptake of the triple therapy regimen, carfilzomib, lenalidomide, and dexamethasone (KRd) at second line.ResultsCompared to alternative first-line care pathways, lenalidomide provides a time to progression advantage of up to 5.1 months. In the baseline scenario, the costs per patient were €40,692 in Year 1. Future Scenario A showed an additional expenditure of €867 per patient in Year 1, increasing to €3358 per patient by Year 5, a 2.1% and 8.2% increase from baseline, respectively. However, lenalidomide use was associated with a lower monthly hospitalisation per-patient cost (€813) compared with bortezomib (€1173) and thalidomide (€1532). Future Scenario B was associated with a 29% increase in cost.ConclusionsCompared to other first line therapies, lenalidomide delays time to progression resulting in associated savings across a patient’s treatment pathway and overall is likely to result in a limited impact on budget. Lenalidomide should, therefore, be considered as a first treatment option for multiple myeloma patients ineligible for transplant.FundingCelgene Ltd.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

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The Cost Impact of Lenalidomide for Newly Diagnosed Multiple Myeloma in the EU5

et al. 2017

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“…This method allows for the selection of untreated patients providing an opportunity to select incident cases or those with SMM. Prior work in the MM population using claims data has relied on the selection of a treated population (15, 16). While the strategy of requiring both appropriate ICD-9-CM codes and the disease-specific treatments can better identify true cases, this approach limits the research question to the treated population and excludes patients who either are at an early disease stage who does not yet require treatment or who forgo treatment for personal or medical reasons.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of an Algorithm to Identify Patients with Multiple Myeloma Using Administrative Claims Data

et al. 2016

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PurposeThe objective was to expand on prior work by developing and validating a new algorithm to identify multiple myeloma (MM) patients in administrative claims.MethodsTwo files were constructed to select MM cases from MarketScan Oncology Electronic Medical Records (EMR) and controls from the MarketScan Primary Care EMR during January 1, 2000–March 31, 2014. Patients were linked to MarketScan claims databases, and files were merged. Eligible cases were age ≥18, had a diagnosis and visit for MM in the Oncology EMR, and were continuously enrolled in claims for ≥90 days preceding and ≥30 days after diagnosis. Controls were age ≥18, had ≥12 months of overlap in claims enrollment (observation period) in the Primary Care EMR and ≥1 claim with an ICD-9-CM diagnosis code of MM (203.0×) during that time. Controls were excluded if they had chemotherapy; stem cell transplant; or text documentation of MM in the EMR during the observation period. A split sample was used to develop and validate algorithms. A maximum of 180 days prior to and following each MM diagnosis was used to identify events in the diagnostic process. Of 20 algorithms explored, the baseline algorithm of 2 MM diagnoses and the 3 best performing were validated. Values for sensitivity, specificity, and positive predictive value (PPV) were calculated.ConclusionThree claims-based algorithms were validated with ~10% improvement in PPV (87–94%) over prior work (81%) and the baseline algorithm (76%) and can be considered for future research. Consistent with prior work, it was found that MM diagnoses before and after tests were needed.

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“…Current challenges for the management of MM, including bortezomib drug treatment, are resistance development to drugs, increased unsustainable cost [9,10], lack of standardization in the therapeutic steps including stem cell transplantation, and morbidity and mortality due to drugs and/or ongoing resistant incurable neoplastic myeloma disease [4,5,11,12,13]. In silico studies are effective for key decision making during clinicopathological battles against the chronic course of MM [3,7,14,15].…”

Section: Introductionmentioning

confidence: 99%

Expression Profiles of the Individual Genes Corresponding to the Genes Generated by Cytotoxicity Experiments with Bortezomib in Multiple Myeloma

Ghasemi¹,

Alpsoy²,

Turk³

et al. 2016

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Objective:Multiple myeloma (MM) is currently incurable due to refractory disease relapse even under novel anti-myeloma treatment. In silico studies are effective for key decision making during clinicopathological battles against the chronic course of MM. The aim of this present in silico study was to identify individual genes whose expression profiles match that of the one generated by cytotoxicity experiments for bortezomib.Materials and Methods:We used an in silico literature mining approach to identify potential biomarkers by creating a summarized set of metadata derived from relevant information. The E-MTAB-783 dataset containing expression data from 789 cancer cell lines including 8 myeloma cell lines with drug screening data from the Wellcome Trust Sanger Institute database obtained from ArrayExpress was “Robust Multi-array analysis” normalized using GeneSpring v.12.5. Drug toxicity data were obtained from the Genomics of Drug Sensitivity in Cancer project. In order to identify individual genes whose expression profiles matched that of the one generated by cytotoxicity experiments for bortezomib, we used a linear regression-based approach, where we searched for statistically significant correlations between gene expression values and IC50 data. The intersections of the genes were identified in 8 cell lines and used for further analysis.Results:Our linear regression model identified 73 genes and some genes expression levels were found to very closely correlated with bortezomib IC50 values. When all 73 genes were used in a hierarchical cluster analysis, two major clusters of cells representing relatively sensitive and resistant cells could be identified. Pathway and molecular function analysis of all the significant genes was also investigated, as well as the genes involved in pathways.Conclusion:The findings of our present in silico study could be important not only for the understanding of the genomics of MM but also for the better arrangement of the targeted anti-myeloma therapies, such as bortezomib.

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Patterns of total cost and economic consequences of progression for patients with newly diagnosed multiple myeloma

Cited by 33 publications

References 24 publications

The Cost Impact of Lenalidomide for Newly Diagnosed Multiple Myeloma in the EU5

The Cost Impact of Lenalidomide for Newly Diagnosed Multiple Myeloma in the EU5

Development and Validation of an Algorithm to Identify Patients with Multiple Myeloma Using Administrative Claims Data

Expression Profiles of the Individual Genes Corresponding to the Genes Generated by Cytotoxicity Experiments with Bortezomib in Multiple Myeloma

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