Treatment Patterns and Healthcare Costs Among Multiple Myeloma Patients Who Maintain Longer First Line of Therapy

• Published in: Blood 2016-12, Vol.128 (22), p.5934-5934
• Main Authors: Maiese, Eric M, Slaton, Terra, Kozma, Chris M
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V128.22.5934.5934

Introduction: The goal of multiple myeloma (MM) treatment is to control disease, prolong survival and improve quality of life (Colson 2015). One piece of evidence that a therapy is working well is the ability to maintain therapy without change. The purpose of this analysis was to describe treatment patterns and costs among MM patients who maintain first line of therapy (LOT) for at least six months. Results of this analysis will provide clinicians and payers with information about factors associated with faster progression through treatment. Methods:A US claims database (Truven Health MarketScan®) was used to identify adult patients with ≥2 MM diagnoses (ICD-9 203.0x) between Jan 1, 2005-Dec 31, 2014 (end of study) with; 1) MM treatment between Jan 1, 2007-Jun 30, 2014 and within 90 days of an MM diagnosis code (date of first MM treatment set as index date); 2) continuous medical insurance 24 months pre and ≥6 months postindex). Patients were excluded if they had 1) MM treatment preindex; 2) non-MM chemo; 3) stem cell transplant, pregnancy or HIV diagnoses. An algorithm was used to identify LOTs based on treatment gaps, changes in therapy and refractory status. Patient characteristics, treatment patterns and costs were assessed for patients without a new LOT within 6 months of starting their first LOT and for patients with a new LOT within 6 months of starting their first LOT. Treated days was defined as the time between the first day of treatment in the LOT until the last day a treatment was available based on the dispensing dates and days supplies. Categorical and continuous measures were tested with Chi-Square tests or independent t-tests, respectively. Differences in costs were tested in a general linear model with a gamma distribution and a log link. Results: Of the 2,936 patients included, 74.7% maintained LOT 1 for at least 6 months (i.e., did not have a LOT 2 within 6 months of starting their LOT 1). The average age of patients who maintained LOT 1 was 71.3 (SD 10.8) years and 56.3% were male. The average age of patients with an LOT 2 (i.e. started LOT 2 within 6 months of starting their LOT 1) was 69.7 (SD 11.0) years and 57.3% were male. Fewer patients without an LOT 2 had Commercial insurance compared to the group with an LOT 2 (25.8% vs. 29.5%). Patients without a LOT 2 were more likely to have had a lenalidomide-based (no PI) regimen for LOT 1 than patients who had an LOT 2 (35.8% vs. 22.3%; p