An Economic Model to Establish the Costs Associated With Routes to Presentation for Patients With Multiple Myeloma in the United Kingdom

• Published in: Value in health regional issues 2023-05, Vol.35, p.27-33
• Main Authors: Porteous, Alex, Gibson, Scott, Eddowes, Lucy A., Drayson, Mark, Pratt, Guy, Bowcock, Stella, Willis, Fenella, Parkin, Hannah, Renwick, Suzanne, Laketic-Ljubojevic, Ira, Howell, Debra, Smith, Alex, Stern, Simon
• Format: Article
• Language: English
• Subjects: Delayed Diagnosis; diagnostic delay; health economics; Humans; Models, Economic; multiple myeloma; Multiple Myeloma - diagnosis; Multiple Myeloma - therapy; myeloma; United Kingdom
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2023.01.001

Patients with myeloma often face significant diagnostic delay, with up to one-third of UK patients diagnosed after an emergency presentation (EP). Compared with other routes, patients presenting as an emergency have more advanced disease, increased complications, and poorer prognosis. An economic model was developed using a decision-tree framework and lifetime time horizon to estimate costs related to different presentation routes (EP, general practitioner [GP] 2-week wait, GP urgent, GP routine, and consultant to consultant) for UK patients diagnosed as having myeloma. After diagnosis, patients received one of 3 first-line management options (observation, active treatment, or end-of-life care). Inputs were derived from UK health technology assessments and targeted literature reviews, or based on authors’ clinical experience where data were unavailable. Active treatment, complication, and end-of-life care costs were included. The average per-patient cost of treating myeloma (across all routes) was estimated at £146 261. The average per-patient cost associated with EP (£152 677) was the highest; differences were minimal compared with GP 2-week wait (£149 631) and consultant to consultant (£147 237). GP urgent (£140 025) and GP routine (£130 212) were associated with marginally lower costs. Complication (£42 252) and end-of-life care (£11 273) costs were numerically higher for EP than other routes (£25 021-£38 170 and £9772-£10 458, respectively). An economic benefit may be associated with earlier diagnosis, gained via reduced complication and end-of-life care costs. Strategies to expedite myeloma diagnosis and minimize EPs have the potential to improve patient outcomes and may result in long-term savings that could offset any upfront costs associated with their implementation. •Patients with multiple myeloma who present as an emergency have a poorer prognosis and additional complications compared with those diagnosed via other routes.•This analysis evaluates the cost associated with various routes of presentation for patients with multiple myeloma and explores the economic impact of diagnosis via emergency presentation, which can be associated with diagnostic delay.•The costs resulting from complications and end-of-life care are higher for patients presenting as an emergency than other routes, suggesting the potential to reduce these costs with earlier diagnosis. Therefore, strategies to expedite myeloma diagnosis and minimize emergency presentations not on