Use of Hospital-at-Home Services for Injectable Chemotherapy for Patients With Multiple Myeloma in France in 2019 and 2020: A Real-World Nationwide Study Based on the French Hospital Discharge Database.

BACKGROUND

Some injectable medicines introduced recently allow patients with multiple myeloma (MM) to receive their chemotherapy at home. This study aimed at describing adult patients with MM receiving injectable chemotherapy via hospital-at-home (HAH) services and outpatient hospital units (OHUs) in metropolitan France in 2019 and 2020, analyzing the factors influencing HAH use, and evaluating the geographic variations and the evolution over time of HAH use by these patients during the study period.

METHODS

Real-world data from the French Hospital Discharge Database (PMSI) were analyzed.

RESULTS

In total, 2169/9278 patients (23.4%) received at least one HAH chemotherapy injection. These patients were diagnosed more recently (mean ± standard deviation = 25.1 ± 19.6 vs. 31.6 ± 21.8 months), and lived in larger and wealthier cities (59,000 vs. 41,000 inhabitants; €23,300 ± €5300 vs. €21,700 ± €4100) and closer to their follow-up hospital (18.7 ± 18.4 vs. 31.3 ± 31.2 km) than patients exclusively treated in OHUs ( < 0.001). Receiving bortezomib and carfilzomib, and the first chemotherapy dose in 2020, were the most significant factors associated with HAH use (odds ratio [95% confidence interval]: 6.12 [5.40-6.96], 2.01 [1.69-2.39], and 1.81 [1.57-2.09], respectively,  < 0.001). HAH use increased between 2019 and 2020 (patients, +23%; administrative departments, +25%), likely related to the COVID-19 pandemic. However, HAH use remained limited overall and exhibited inter-regional variability. Infection-related hospitalizations remained stable.

CONCLUSIONS

Receiving chemotherapy injections at home is feasible and safe, but further development and equitable access are essential to enhance patients' quality of life and reduce costs.