Petrucci Maria Teresa, Calabrese Elisabetta, Levi Anna, Federico Vincenzo, Ceccolini Michela, Rizzi Rita, Gozzetti Alessandro, Falco Patrizia, Lazzaro Carlo, Martelli Elisa, Boccadoro Mario, Lauria Francesco, Liso Vincenzo, Cavo Michele, Foa Robert
Tumori. 2013 Jul-Aug;99(4):e193-202. doi: 10.1177/030089161309900434.
Multiple myeloma is the second most common hematological cancer. Although it accounts for only a relatively small percentage of all cancer types, the costs associated with managing multiple myeloma are considerable. Available studies are mainly focused on health care costs. The Costo del Mieloma Multiplo (Cost of MM, CoMiM) study investigated the cost of illness of multiple myeloma in Italy during one year of disease management.
CoMiM is a retrospective, prevalence-based, multi-center, cross-sectional study based on a stratified sample of patients seen during normal clinical practice (asymptomatic; symptomatic on drugs; symptomatic receiving autologous stem cell transplantation; plateau/remission). Demographics, clinical history, health care and non-health care resource consumption data were collected. Costs were evaluated from the societal viewpoint and expressed in Euro 2008.
Data on 236 patients were analyzed (39 asymptomatic, 17%; 29 symptomatic receiving autologous stem-cell transplantation, 12%; 105 symptomatic receiving drugs, 44%; 63 plateau/remission, 27%). The total cost of illness reached € 19,267.1 ± 25,078.6 (asymptomatic, € 959.3 ± 1091.6; symptomatic receiving drugs, € 21,707.8 ± 21,785.3; symptomatic receiving autologous stem-cell transplantation, € 59,243.7 ± 24,214.0; plateau/remission, € 8130.7 ± 15,092.5). The main cost drivers of total cost of illness were drugs and hospital admissions (46.1% and 29.4%, respectively). Antineoplastics and immunomodulators drove the cost of drugs (21.6% and 21.1% of the total cost of illness). Cost of antineoplastics was led by bortezomib (97.4%), whereas the cost driver for immunomodulators was lenalidomide (99.4%). Cost of hospitalization funded by the Italian National Health Service was strongly influenced by transplantation (94.6%), whereas chemotherapy and skeletal fractures did not exceed 1% and 2%, respectively.
Despite some limitations, the CoMiM study provides Italian health care decision-makers with an insight into the stratified cost of illness of multiple myeloma patients.
多发性骨髓瘤是第二常见的血液系统癌症。尽管它在所有癌症类型中所占比例相对较小，但多发性骨髓瘤的治疗费用相当可观。现有研究主要集中在医疗保健成本方面。多发性骨髓瘤成本（Costo del Mieloma Multiplo，CoMiM）研究调查了意大利在一年疾病管理期间多发性骨髓瘤的疾病成本。
CoMiM是一项基于患病率的回顾性、多中心横断面研究，基于正常临床实践中所见患者的分层样本（无症状；药物治疗有症状；接受自体干细胞移植有症状；平台期/缓解期）。收集了人口统计学、临床病史、医疗保健和非医疗保健资源消耗数据。从社会角度评估成本，并以2008年欧元表示。
分析了236例患者的数据（39例无症状，17%；29例接受自体干细胞移植有症状，12%；105例药物治疗有症状，44%；63例平台期/缓解期，27%）。疾病总成本达到19,267.1±25,078.6欧元（无症状，959.3±1091.6欧元；药物治疗有症状，21,707.8±21,785.3欧元；接受自体干细胞移植有症状，59,243.7±24,214.0欧元；平台期/缓解期，8130.7±15,092.5欧元）。疾病总成本的主要成本驱动因素是药物和住院（分别为46.1%和29.4%）。抗肿瘤药和免疫调节剂推动了药物成本（分别占疾病总成本的21.6%和21.1%）。抗肿瘤药成本以硼替佐米为主（97.4%），而免疫调节剂的成本驱动因素是来那度胺（99.4%）。由意大利国家卫生服务机构资助的住院成本受移植影响很大（94.6%），而化疗和骨折分别不超过1%和2%。
尽管存在一些局限性，但CoMiM研究为意大利医疗保健决策者提供了对多发性骨髓瘤患者分层疾病成本的洞察。
