Health Care Costs and Resource Utilization, Including Patient Burden, Associated With Novel‐Agent‐Based Treatment Versus Other Therapies for Multiple Myeloma: Findings Using Real‐World Claims Data

• Published in: The oncologist (Dayton, Ohio) Vol. 18; no. 1; pp. 37 - 45
• Main Authors: Teitelbaum, April, Ba‐Mancini, Abbie, Huang, Hui, Henk, Henry J.
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.01.2013
• Subjects: Adult; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - economics; Boronic Acids - administration & dosage; Bortezomib; Cost analysis; Cost of illness; Economics of Oncology Practice; Female; Health Care Costs; Health Resources - economics; Hospitalization - economics; Humans; Male; Medicare; Middle Aged; Multiple myeloma; Multiple Myeloma - drug therapy; Multiple Myeloma - economics; Multiple Myeloma - epidemiology; Pyrazines - administration & dosage; Retrospective Studies; Thalidomide - administration & dosage; Thalidomide - analogs & derivatives
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2012-0113

Background. Treatment of multiple myeloma has dramatically improved with the introduction of bortezomib (BOR), thalidomide (THAL), and lenalidomide (LEN). Studies assessing health care costs, particularly economic burden on patients, are limited. We conducted a claims‐based, retrospective analysis of total health care costs as well as patient burden (patient out‐of‐pocket costs and number of ambulatory/hospital visits) associated with BOR/THAL/LEN treatment versus other therapies (OTHER). Methods. Treatment episodes starting between January 1, 2005 and September 30, 2010 were identified from the claims database of a large U.S. health plan. Health care costs and utilization were measured during 1 year after initiation and analyzed per treatment episode. Multivariate analyses were used to adjust for patient characteristics, comorbidities, and line of treatment. Results. A total of 4,836 treatment episodes were identified. Mean adjusted total costs were similar between BOR ($112,889) and OTHER ($111,820), but higher with THAL ($129,412) and LEN ($158,428). Mean adjusted patient out‐of‐pocket costs were also similar for BOR ($3,846) and OTHER ($3,900) but remained higher with THAL ($4,666) and LEN ($4,483). Mean adjusted rates of ambulatory visits were similar across therapies (BOR: 69.67; THAL: 66.31; LEN: 65.60; OTHER: 69.42). Conclusions. Adjusted analyses of real‐world claims data show that total health care costs, as well as patient out‐of‐pocket costs, are higher with THAL/LEN treatment episodes than with BOR/OTHER therapies. Additionally, similar rates of ambulatory visits suggest that any perceived advantage in patient convenience of the orally administered drugs THAL/LEN is not supported by these data. 摘要 背景. 硼替佐米（BOR）、沙利度胺（THAL）及来那度胺（LEN）问世后，多发性骨髓瘤的治疗得到大幅改善。但评估医疗花费，特别是患者经济负担的研究有限。本研究对BOR/THAL/LEN治疗与其他疗法（OTHER）相关的医疗总成本和患者负担（患者自费成本和就诊次数）进行了基于支付数据的回顾性分析。 方法. 从美国一家大型医疗保险公司的支付数据库调阅2005年1月1日至2010年9月30日开始的治疗。计算开始治疗后1年内的医疗成本和资源占用，按每次治疗进行分析。采用多因素分析校正患者特征、并存疾病和治疗线数。 结果. 共检出4 836个治疗。BOR的平均校正总成本（112 889美元）接近OTHER（111 820美元），但THAL（129 412美元）和LEN（158 428美元）的平均校正总成本较高。BOR的平均校正患者自费成本（3846美元）也接近OTHER（3 900美元），但THAL（4 666美元）和LEN（4 483美元）的成本仍然较高。各疗法的平均校正就诊率接近（BOR：69.67；THAL：66.31；LEN：65.60；OTHER：69.42）。 结论. 真实世界支付数据的校正分析显示，THAL/LEN治疗的总医疗花费和患者自费成本高于BOR/OTHER疗法。此外，就诊率数据不相上下，提示THAL/LEN口服给药的便利性并不象人们感觉上的那样具有优势。 This claims‐based, retrospective analysis examines total health care costs and patient burden associated with bortezomib, thalidomide, and lenalidomide treatment versus other therapies for multiple myeloma. Total health care costs and patient out‐of‐pocket costs were found to be higher for thalidomide and lenalidomide than for bortezomib and other therapies.