Ouchveridze Evguenia, Berger Katherine, Mohyuddin Ghulam Rehman
Department of Hematological Malignancies and Cellular Therapeutics, Suite 210, Kansas University Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, 66205, USA.
University of Hartford, West Hartford, CT, USA.
Curr Hematol Malig Rep. 2022 Dec;17(6):206-216. doi: 10.1007/s11899-022-00669-1. Epub 2022 Aug 30.
Despite tremendous advances in multiple myeloma (MM) care, the disease maintains considerable morbidity and requires long-term treatment associated with significant financial toxicity to patients and high costs to society. In this review, we explore why - despite treatment advances - value in MM treatment is largely a myth, then explain some ways the myth might become a reality.
We discuss how value-based care in MM should include patient-centered outcomes such as financial toxicity and quality of life, which are heavily impacted by cost of drugs and the indefinite duration of therapy that is standard in MM treatment. We propose multiple paths to work toward reducing cost and augmenting value of care for patients with MM, including improving access to generic drugs, increasing federal funding for clinical trials, designing more patient-centric clinical trials, and exploring the utilization of minimal residual disease (MRD)-driven treatment de-escalation, among others. We remain optimistic that despite the challenges, we can work toward making progress in the realm of value-based care for patients with MM and make it a reality.
尽管多发性骨髓瘤（MM）治疗取得了巨大进展，但该疾病仍具有相当高的发病率，需要长期治疗，这给患者带来了巨大的经济负担，并给社会造成了高昂的成本。在本综述中，我们探讨了为何尽管治疗取得了进展，但MM治疗的价值在很大程度上仍是一个神话，然后解释了一些使这个神话成为现实的方法。
我们讨论了MM的基于价值的治疗应如何纳入以患者为中心的结果，如经济毒性和生活质量，这些结果受到药物成本和MM治疗标准的无限期治疗时间的严重影响。我们提出了多条途径来努力降低成本并提高MM患者的护理价值，包括改善仿制药的可及性、增加联邦对临床试验的资金投入、设计更以患者为中心的临床试验，以及探索利用微小残留病（MRD）驱动的治疗降阶梯等。我们仍然乐观地认为，尽管存在挑战，但我们可以在MM患者的基于价值的护理领域取得进展并使其成为现实。
