Multiple Myeloma Diagnosis and Care Could be Associated With Substantial Financial Burden on Medicare

Contemporary Concepts | <b>Contemporary Concepts in Hematologic Oncology</b>

Investigators have identified an association between the diagnosis and care of older patients with multiple myeloma and substantial financial burden on Medicare.

There may be an association between the diagnosis and treatment of multiple myeloma in older patients and a substantial economic burden to Medicare across different phases of care, according to findings from a study published in JAMA Network Open.

Patients with multiple myeloma had a mean adjusted incremental lifetime cost of $184,495 (95% CI, $183,099-$185,968). Additionally, the estimated mean per member, per month phase-specific incremental monthly cost was $1244 (95% CI, $1216-$1272) in the pre-diagnosis phase, $11,181 (95% CI, $11,052-$11,309) in the initial phase, $5634 (95% CI, $5577-$5694) in the continuing care phase, and $6280 (95% CI, $6248-$6314) in the terminal phase.

“Our study used a data-driven approach to identify the duration of initial and terminal phases of care along the [multiple myeloma] care continuum and highlighted the substantial economic burden associated with [multiple myeloma] diagnosis and care. Findings on the economic burden of [multiple myeloma], including its lifetime and phase-specific costs, and cost drivers in each phase of [multiple myeloma] care can aid policy discussions regarding care and coverage. The findings of this study can also be used to help the development of bundled payment models specific to [multiple myeloma], adjusting for costs across various phases of the disease continuum and their associated factors,” investigators of the study wrote.

A total of 4533 patients newly diagnosed multiple myeloma and 4533 noncancer beneficiaries were included in this analysis. Among the patients diagnosed with multiple myeloma, 2374 were women, 3418 were White, and the mean age was 75.8 years. Patients in the control group had similar characteristics.

At month 4, a statistically significant inflection point of monthly cost trends was identified, with a monthly percent change of –15.0% (95% CI, –17.7% to –12.2%). At month 3, investigators found a statistically significant inflection point in monthly trend costs, with a monthly percent change of 20.8% (95% CI, 17.3%-24.1%), and at month 8 the monthly change was 6.9% (95% CI, 5.4%-8.4%) before death. After these findings were identified, investigators determined that the duration of initial and terminal phases were defined as the 4-month period prior to being diagnosed with the diseasd and the 3-month period before death.

The mean lifetime costs were higher for Medicare beneficiaries at $212,474 compared with $54,539.60 in matched noncancer counterparts. The per member per month costs across all phases of care were $2080.90 vs $1566.80 at pre-diagnosis, $10,384.50 vs $1618.20 at initial care, $6082.80 vs $1495.00 with continuing care, and $14,417.00 vs $8853.10 for terminal care among the beneficiary and matched noncancer groups, respectively.

The mean adjusted lifetime cost of in the multiple myeloma group of $234,002 (95% CI, $232,232-$235,870) was significantly greater than that of the noncancer group at $49,507 (95% CI, $49,133-$49,903).

Investigators estimated that inpatient services followed by outpatient services were major cost driver in multiple myeloma in the pre-diagnosis, initial care, and terminal care phases. However, the cost of prescription drugs was the most significant cost driver for those in the continuing care phase

“The findings of this study suggest that there is substantial burden to Medicare associated with diagnosis and care among older adults with [multiple myeloma], and the cost of care and cost drivers vary across different phases of the cancer care continuum. The study findings might aid policy discussions regarding [multiple myeloma] care and coverage and help further the development of alternative payment models for [multiple myeloma], accounting for differential costs across various phases of the disease continuum and their drivers.,” the investigators concluded.

Reference

Bhattacharya K, Bentley JP, Ramachandran S, et al. Phase-specific and lifetime costs of multiple myeloma among older adults in the US. JAMA Netw Open. Published online July 1, 2021. doi:10.1001/jamanetworkopen.2021.16357