Cost Offsets in the Treatment Journeys of Patients With Relapsed/Refractory Multiple Myeloma

Sikander Ailawadhi, Maral DerSarkissian, Mei Sheng Duh, Marie Hélène Lafeuille, George Posner, Stephen Ralston, Erin Zagadailov, Abbie Ba-Mancini, Robert Rifkin

Research output: Contribution to journalArticle

Abstract

Purpose: Multiple new regimens are available for the treatment of relapsed/refractory multiple myeloma (RRMM). In this context, it is increasingly important to understand the differential costs of regimens used to treat RRMM. Methods: A treatment journey for RRMM during a 12-month period of therapy was developed to reflect real-world clinical practice based on current treatment guidelines and input from hematologists/oncologists. The journey incorporated prescreening visits, laboratory tests, regimen-specific premedication, treatment-related costs, medical costs, and indirect costs. A cost model was constructed from the standard RRMM treatment pathway to compare overall, direct, and indirect costs across therapies over a 12-month period from initiation of second-line therapy and to determine cost offsets (incremental costs) associated with use of ixazomib-based therapy versus comparator regimens. According to the clinical input, the standard pathway was modified for patients with high unmet need to determine specific cost offsets in these subgroups. Findings: Total costs ranged from $93,683 for bortezomib-cyclophosphamide-dexamethasone to $315,296 for daratumumab-bortezomib-dexamethasone. Drug cost comprised the highest proportion (83%–98%) of total costs of second-line therapy across regimens, which were generally highest for regimens based on recently approved agents. Indirect costs were higher for regimens that required more frequent or longer durations of drug administration, and lower for all-oral regimens. Costs were reduced among frail patients because of the use of adjusted dosing, whereas indirect costs were increased for regimens that required a greater number of clinic visits among patients with barriers to physician access. Implications: Cost model analyses highlight the differential direct and indirect costs associated with multiple regimens for the treatment of RRMM, including many recent new regimens. The results indicate the lower treatment burden and indirect costs associated with administering all-oral regimens compared with regimens that require frequent and/or lengthy subcutaneous or intravenous infusions. Understanding comparative costs associated with the treatment journeys of different patients with RRMM may help inform payer and patient therapeutic choices. (Clin Ther. 2019;41:XXX–XXX).

Original languageEnglish (US)
JournalClinical therapeutics
DOIs
StatePublished - Jan 1 2019

Fingerprint

Multiple Myeloma
Costs and Cost Analysis
Therapeutics
Dexamethasone
Subcutaneous Infusions
Drug Costs
Premedication
Ambulatory Care
Intravenous Infusions
Health Care Costs
Cyclophosphamide

Keywords

  • cost offsets
  • direct costs
  • indirect costs
  • multiple myeloma
  • oral therapies

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Cost Offsets in the Treatment Journeys of Patients With Relapsed/Refractory Multiple Myeloma. / Ailawadhi, Sikander; DerSarkissian, Maral; Duh, Mei Sheng; Lafeuille, Marie Hélène; Posner, George; Ralston, Stephen; Zagadailov, Erin; Ba-Mancini, Abbie; Rifkin, Robert.

In: Clinical therapeutics, 01.01.2019.

Research output: Contribution to journalArticle

Ailawadhi, S, DerSarkissian, M, Duh, MS, Lafeuille, MH, Posner, G, Ralston, S, Zagadailov, E, Ba-Mancini, A & Rifkin, R 2019, 'Cost Offsets in the Treatment Journeys of Patients With Relapsed/Refractory Multiple Myeloma', Clinical therapeutics. https://doi.org/10.1016/j.clinthera.2019.01.009
Ailawadhi, Sikander ; DerSarkissian, Maral ; Duh, Mei Sheng ; Lafeuille, Marie Hélène ; Posner, George ; Ralston, Stephen ; Zagadailov, Erin ; Ba-Mancini, Abbie ; Rifkin, Robert. / Cost Offsets in the Treatment Journeys of Patients With Relapsed/Refractory Multiple Myeloma. In: Clinical therapeutics. 2019.
@article{cf2e8ea0fe0b4f91914036c69a9715f3,
title = "Cost Offsets in the Treatment Journeys of Patients With Relapsed/Refractory Multiple Myeloma",
abstract = "Purpose: Multiple new regimens are available for the treatment of relapsed/refractory multiple myeloma (RRMM). In this context, it is increasingly important to understand the differential costs of regimens used to treat RRMM. Methods: A treatment journey for RRMM during a 12-month period of therapy was developed to reflect real-world clinical practice based on current treatment guidelines and input from hematologists/oncologists. The journey incorporated prescreening visits, laboratory tests, regimen-specific premedication, treatment-related costs, medical costs, and indirect costs. A cost model was constructed from the standard RRMM treatment pathway to compare overall, direct, and indirect costs across therapies over a 12-month period from initiation of second-line therapy and to determine cost offsets (incremental costs) associated with use of ixazomib-based therapy versus comparator regimens. According to the clinical input, the standard pathway was modified for patients with high unmet need to determine specific cost offsets in these subgroups. Findings: Total costs ranged from $93,683 for bortezomib-cyclophosphamide-dexamethasone to $315,296 for daratumumab-bortezomib-dexamethasone. Drug cost comprised the highest proportion (83{\%}–98{\%}) of total costs of second-line therapy across regimens, which were generally highest for regimens based on recently approved agents. Indirect costs were higher for regimens that required more frequent or longer durations of drug administration, and lower for all-oral regimens. Costs were reduced among frail patients because of the use of adjusted dosing, whereas indirect costs were increased for regimens that required a greater number of clinic visits among patients with barriers to physician access. Implications: Cost model analyses highlight the differential direct and indirect costs associated with multiple regimens for the treatment of RRMM, including many recent new regimens. The results indicate the lower treatment burden and indirect costs associated with administering all-oral regimens compared with regimens that require frequent and/or lengthy subcutaneous or intravenous infusions. Understanding comparative costs associated with the treatment journeys of different patients with RRMM may help inform payer and patient therapeutic choices. (Clin Ther. 2019;41:XXX–XXX).",
keywords = "cost offsets, direct costs, indirect costs, multiple myeloma, oral therapies",
author = "Sikander Ailawadhi and Maral DerSarkissian and Duh, {Mei Sheng} and Lafeuille, {Marie H{\'e}l{\`e}ne} and George Posner and Stephen Ralston and Erin Zagadailov and Abbie Ba-Mancini and Robert Rifkin",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.clinthera.2019.01.009",
language = "English (US)",
journal = "Clinical Therapeutics",
issn = "0149-2918",
publisher = "Excerpta Medica",

}

TY - JOUR

T1 - Cost Offsets in the Treatment Journeys of Patients With Relapsed/Refractory Multiple Myeloma

AU - Ailawadhi, Sikander

AU - DerSarkissian, Maral

AU - Duh, Mei Sheng

AU - Lafeuille, Marie Hélène

AU - Posner, George

AU - Ralston, Stephen

AU - Zagadailov, Erin

AU - Ba-Mancini, Abbie

AU - Rifkin, Robert

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Multiple new regimens are available for the treatment of relapsed/refractory multiple myeloma (RRMM). In this context, it is increasingly important to understand the differential costs of regimens used to treat RRMM. Methods: A treatment journey for RRMM during a 12-month period of therapy was developed to reflect real-world clinical practice based on current treatment guidelines and input from hematologists/oncologists. The journey incorporated prescreening visits, laboratory tests, regimen-specific premedication, treatment-related costs, medical costs, and indirect costs. A cost model was constructed from the standard RRMM treatment pathway to compare overall, direct, and indirect costs across therapies over a 12-month period from initiation of second-line therapy and to determine cost offsets (incremental costs) associated with use of ixazomib-based therapy versus comparator regimens. According to the clinical input, the standard pathway was modified for patients with high unmet need to determine specific cost offsets in these subgroups. Findings: Total costs ranged from $93,683 for bortezomib-cyclophosphamide-dexamethasone to $315,296 for daratumumab-bortezomib-dexamethasone. Drug cost comprised the highest proportion (83%–98%) of total costs of second-line therapy across regimens, which were generally highest for regimens based on recently approved agents. Indirect costs were higher for regimens that required more frequent or longer durations of drug administration, and lower for all-oral regimens. Costs were reduced among frail patients because of the use of adjusted dosing, whereas indirect costs were increased for regimens that required a greater number of clinic visits among patients with barriers to physician access. Implications: Cost model analyses highlight the differential direct and indirect costs associated with multiple regimens for the treatment of RRMM, including many recent new regimens. The results indicate the lower treatment burden and indirect costs associated with administering all-oral regimens compared with regimens that require frequent and/or lengthy subcutaneous or intravenous infusions. Understanding comparative costs associated with the treatment journeys of different patients with RRMM may help inform payer and patient therapeutic choices. (Clin Ther. 2019;41:XXX–XXX).

AB - Purpose: Multiple new regimens are available for the treatment of relapsed/refractory multiple myeloma (RRMM). In this context, it is increasingly important to understand the differential costs of regimens used to treat RRMM. Methods: A treatment journey for RRMM during a 12-month period of therapy was developed to reflect real-world clinical practice based on current treatment guidelines and input from hematologists/oncologists. The journey incorporated prescreening visits, laboratory tests, regimen-specific premedication, treatment-related costs, medical costs, and indirect costs. A cost model was constructed from the standard RRMM treatment pathway to compare overall, direct, and indirect costs across therapies over a 12-month period from initiation of second-line therapy and to determine cost offsets (incremental costs) associated with use of ixazomib-based therapy versus comparator regimens. According to the clinical input, the standard pathway was modified for patients with high unmet need to determine specific cost offsets in these subgroups. Findings: Total costs ranged from $93,683 for bortezomib-cyclophosphamide-dexamethasone to $315,296 for daratumumab-bortezomib-dexamethasone. Drug cost comprised the highest proportion (83%–98%) of total costs of second-line therapy across regimens, which were generally highest for regimens based on recently approved agents. Indirect costs were higher for regimens that required more frequent or longer durations of drug administration, and lower for all-oral regimens. Costs were reduced among frail patients because of the use of adjusted dosing, whereas indirect costs were increased for regimens that required a greater number of clinic visits among patients with barriers to physician access. Implications: Cost model analyses highlight the differential direct and indirect costs associated with multiple regimens for the treatment of RRMM, including many recent new regimens. The results indicate the lower treatment burden and indirect costs associated with administering all-oral regimens compared with regimens that require frequent and/or lengthy subcutaneous or intravenous infusions. Understanding comparative costs associated with the treatment journeys of different patients with RRMM may help inform payer and patient therapeutic choices. (Clin Ther. 2019;41:XXX–XXX).

KW - cost offsets

KW - direct costs

KW - indirect costs

KW - multiple myeloma

KW - oral therapies

UR - http://www.scopus.com/inward/record.url?scp=85061427156&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061427156&partnerID=8YFLogxK

U2 - 10.1016/j.clinthera.2019.01.009

DO - 10.1016/j.clinthera.2019.01.009

M3 - Article

JO - Clinical Therapeutics

JF - Clinical Therapeutics

SN - 0149-2918

ER -