1 Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, Virginia.
2 Millennium Pharmaceuticals, Cambridge, Massachusetts.
J Manag Care Spec Pharm. 2018 Oct;24(10):1019-1026. doi: 10.18553/jmcp.2018.24.10.1019.
The use of novel drug agents in the treatment of multiple myeloma (MM) has been associated with improved therapeutic outcomes and survival; however, MM continues to pose a significant economic burden on patients and health care systems. Evaluating economic implications of therapies can provide key points of distinctions between available treatment options. Patients with MM may experience productivity loss, including lost days from work or inability to work due to MM symptoms or to undergoing treatment. Although direct costs of illness have been well described in the literature, indirect costs associated with MM are understudied.
To compare the extent of disability benefit use and resultant workplace productivity loss among U.S. adult patients with newly diagnosed MM who received oral versus injectable MM therapy.
A retrospective cohort study was conducted using the Truven Health Analytics MarketScan Commercial Claims and Encounters, Medicare Supplemental Coordination of Benefits, and Health and Productivity Management databases (2008-2015). Workplace absenteeism, as measured by disability benefit use, was evaluated 1 year before and 1 year after first MM diagnosis. Patients receiving only oral chemotherapy were compared with those who received injectable therapy. Absenteeism days and associated costs were compared among study groups using multivariable zero-inflated Poisson regression.
The final study cohort included 299 patients with newly diagnosed MM, of whom 73 received oral therapy only and 226 received injectable therapy. Treatment type was a significant predictor of disability benefit use. Patients who received injectable therapy missed an average of 110 work days in the 1 year after diagnosis, compared with 87 for patients receiving only oral therapy (difference of 23 days, 95% CI = 19-26, P < 0.001). Treatment type was also a significant predictor of costs associated with lost productivity. Patients who received injectable therapy experienced productivity loss valued at $18,315, compared with patients who only received oral drug therapy ($14,429). The difference between these estimates was statistically significant ($3,886, 95% CI = $3,540-$4,231, P < 0.001).
Patients newly diagnosed with MM face significant losses in productivity. Patients receiving injectable MM therapy use significantly more disability benefits and incur higher productivity costs, compared with those receiving oral MM therapy. Further studies elucidating the nature of the differences between injectable and noninjectable chemotherapy users are needed.
This study was funded by Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical Company. Yong and Noga are employees of Millennium Pharmaceuticals. Merola reports personal fees from Millennium Pharmaceuticals during the time of this study.
新型药物在多发性骨髓瘤（MM）治疗中的应用与改善的治疗效果和生存有关；然而，MM 仍然给患者和医疗保健系统带来巨大的经济负担。评估治疗的经济影响可以为现有治疗方案之间的差异提供关键要点。MM 患者可能会出现生产力下降，包括因 MM 症状或接受治疗而缺勤或无法工作。虽然文献中已经很好地描述了疾病的直接成本，但与 MM 相关的间接成本研究较少。
比较接受口服与注射 MM 治疗的新诊断 MM 美国成年患者残疾福利使用情况和由此导致的工作场所生产力损失。
使用 Truven Health Analytics MarketScan 商业索赔和遭遇、医疗保险补充协调福利以及健康和生产力管理数据库（2008-2015 年）进行回顾性队列研究。通过残疾福利使用情况评估 1 年前和首次 MM 诊断后 1 年的工作场所缺勤情况。仅接受口服化疗的患者与接受注射治疗的患者进行比较。使用多变量零膨胀泊松回归比较研究组的缺勤天数和相关成本。
最终的研究队列包括 299 例新诊断的 MM 患者，其中 73 例仅接受口服治疗，226 例接受注射治疗。治疗类型是残疾福利使用的显著预测因素。接受注射治疗的患者在诊断后 1 年内平均缺勤 110 天，而仅接受口服治疗的患者为 87 天（差异为 23 天，95%CI=19-26，P<0.001）。治疗类型也是与生产力损失相关的成本的显著预测因素。接受注射治疗的患者的生产力损失价值为 18315 美元，而仅接受口服药物治疗的患者为 14429 美元。这些估计值之间存在统计学显著差异（3886 美元，95%CI=3540-4231 美元，P<0.001）。
新诊断为 MM 的患者面临着生产力的重大损失。接受注射 MM 治疗的患者比接受口服 MM 治疗的患者使用更多的残疾福利并产生更高的生产力成本。需要进一步研究阐明注射和非注射化疗使用者之间差异的性质。
这项研究由千禧制药公司（Millennium Pharmaceuticals）资助，千禧制药公司是武田制药公司的全资子公司。Yong 和 Noga 是千禧制药公司的员工。Merola 在本研究期间报告了来自千禧制药公司的个人酬金。
