Maiese Eric M, Evans Kristin A, Chu Bong-Chul, Irwin Debra E
An employee of and owns stocks in Janssen.
Truven Health Analytics, and received research funding from Janssen for this study.
Am Health Drug Benefits. 2018 Feb;11(1):39-46.
In recent years, the development of new therapies for multiple myeloma has improved the survival of patients, but newer treatments may also affect healthcare costs. To date, no real-world study has examined the concurrent changes in survival and total healthcare costs over time in patients with multiple myeloma.
To examine the temporal changes in survival and healthcare costs among patients with multiple myeloma in the United States.
This retrospective claims-based cohort study is based on death files in the Truven Health MarketScan Research Commercial and Medicare Supplemental databases. The study included adults who had at least 1 inpatient or 2 outpatient claims with a diagnosis of multiple myeloma between January 1, 2006, and December 31, 2014; continuous insurance enrollment for at least 12 months before and at least 30 days after the first diagnosis (ie, index date); and no previous malignancy. Patients were followed from the index date through the earliest among (1) the date of death recorded in the death files, (2) the end of enrollment in the MarketScan database, or (3) end of the study (September 30, 2015). The mortality rates and the total all-cause and multiple myeloma-specific healthcare costs per patient per month were compared between patients diagnosed in 2006-2010 and those diagnosed in 2011-2014.
A total of 5199 patients were included in the study (2597 diagnosed between 2006 and 2010 and 2602 diagnosed between 2011 and 2014). We found a 35% decrease in the risk for death (hazard ratio, 0.65; 95% confidence interval, 0.57-0.74) among patients diagnosed in 2011-2014 compared with those diagnosed in 2006-2010. In addition, 18% and 26% increases were found in all-cause and multiple myeloma-specific healthcare costs, respectively, over the same time period (adjusted mean all-cause costs, $13,960 vs $16,449, respectively; adjusted mean multiple myeloma-specific costs, $7476 vs $9422, respectively).
The percent decrease in mortality in patients with multiple myeloma has been greater than the percent increase in healthcare costs in recent years, which may be attributable to improved treatments for multiple myeloma and changes in disease management. With the mortality rate having decreased more than the increase in healthcare costs over the same time period, the results of this study suggest that although healthcare spending has increased over time, there is a survival benefit.
近年来，多发性骨髓瘤新疗法的发展提高了患者的生存率，但新疗法也可能影响医疗成本。迄今为止，尚无真实世界研究考察多发性骨髓瘤患者的生存率和总医疗成本随时间的同步变化情况。
考察美国多发性骨髓瘤患者生存率和医疗成本的时间变化情况。
这项基于索赔记录的回顾性队列研究以Truven Health MarketScan研究商业数据库和医疗保险补充数据库中的死亡档案为基础。研究纳入了在2006年1月1日至2014年12月31日期间至少有1次住院或2次门诊索赔且诊断为多发性骨髓瘤的成年人；在首次诊断前至少12个月及诊断后至少30天（即索引日期）持续参保；且既往无恶性肿瘤病史。患者从索引日期开始随访，直至最早出现以下情况之一：（1）死亡档案中记录的死亡日期；（2）MarketScan数据库参保结束；或（3）研究结束（2015年9月30日）。比较了2006 - 2010年诊断的患者与2011 - 2014年诊断的患者的死亡率以及每位患者每月的全因和多发性骨髓瘤特异性总医疗成本。
该研究共纳入5199例患者（2006年至2010年诊断的有2597例，2011年至2014年诊断的有2602例）。我们发现，与2006 - 2010年诊断的患者相比，2011 - 2014年诊断的患者死亡风险降低了35%（风险比为0.65；95%置信区间为0.57 - 0.74）。此外，在同一时期，全因和多发性骨髓瘤特异性医疗成本分别增加了18%和26%（调整后的平均全因成本分别为13,960美元和16,449美元；调整后的平均多发性骨髓瘤特异性成本分别为7476美元和9422美元）。
近年来，多发性骨髓瘤患者死亡率的下降百分比大于医疗成本的增加百分比，这可能归因于多发性骨髓瘤治疗的改善和疾病管理的变化。由于同一时期死亡率的下降幅度超过了医疗成本的增加幅度，本研究结果表明，尽管医疗支出随时间增加，但存在生存获益。
