Trends in overall survival and costs of multiple myeloma, 2000-2014

Abstract

Little real-world evidence is available to describe the recent trends in treatment costs and outcomes for patients with multiple myeloma (MM). Using the Truven Health MarketScan Research Databases linked with social security administration death records, this study found that the percentage of MM patients using novel therapy continuously increased from 8.7% in 2000 to 61.3% in 2014. Compared with MM patients diagnosed in earlier years, those diagnosed after 2010 had higher rates of novel therapy use and better survival outcomes; patients diagnosed in 2012 were 1.25 times more likely to survive 2 years than those diagnosed in 2006. MM patients showed improved survival over the study period, with the 2-year survival gap between MM patients and matched controls decreasing at a rate of 3% per year. Total costs among MM patients have increased in all healthcare services over the years; however, the relative contribution of drug costs has remained fairly stable since 2009 despite new novel therapies coming to market. Findings from this study corroborate clinical data, suggesting a paradigm shift in MM treatment over the past decade that is associated with substantial survival gains. Future studies should focus on the impact on specific novel agents on patients' outcomes.

Figure 1

Patient selection.

Figure 2

Multiple myeloma treatment used within 1 year after diagnosis, by year of diagnosis. Note: novel treatment include: bortezomib, carfilzomib, lenalidomide, panobinostat, pomalidomide and thalidomide. Non-novel treatment include: arsenic trioxide, bendamustine, busulfan, cisplatin, cyclophosphamide, doxorubicin, etoposide, melphalan, prednisone, dexamethasone, rituximab, vincristine and vorinostat.

Figure 3

Survival estimates of matched MM patients and controls, by year of diagnosis. *Year ranges represent the year of diagnosis. Log-rank tests were used to evaluate the difference in survival distributions of two groups. Note: by linking to the SSA Master Death File, survival was measured as time from diagnosis date to the date of death obtained from the SSA, time from diagnosis date to the date of inpatient death, or time from diagnosis date to 30 September 2015; survival estimates were presented for multiple myeloma patients diagnosed and treated during 2006–2012 (n=9521).

Figure 4

Percentage of patients who survived at least 2 years between matched MM patients and controls. Note: by linking to the SSA Master Death File, survival was measured as time from diagnosis date to the date of death obtained from the SSA, time from diagnosis date to the date of inpatient death, or time from diagnosis date to 30 September 2015; survival rates are presented for multiple myeloma patients diagnosed and treated during 2006–2012 (n=9521).

Figure 5

(a) Trends in PPPM total and component costs, by year of diagnosis. Note: costs are measured as PPPM and calculated as (costs/number of days of enrollment) × 30 days; outpatient services include emergency room, physician visits, laboratory, radiology and infusion administration services. (b) Total PPPM all-cause healthcare costs, by year of diagnosis. Note: costs are measured as PPPM and calculated as (costs/number of days of enrollment) × 30 days; MM treatment-related drug costs include outpatient pharmacy prescription costs (NDC codes) and injectable costs from outpatient services (HCPCS codes).