TY - JOUR
T1 - Racial disparity in utilization of therapeutic modalities among multiple myeloma patients
T2 - a SEER-medicare analysis
AU - Ailawadhi, Sikander
AU - Frank, Ryan D.
AU - Advani, Pooja
AU - Swaika, Abhisek
AU - Temkit, M'hamed
AU - Menghani, Richa
AU - Sharma, Mayank
AU - Meghji, Zahara
AU - Paulus, Shumail
AU - Khera, Nandita
AU - Hashmi, Shahrukh K.
AU - Paulus, Aneel
AU - Kakar, Tanya S.
AU - Hodge, David O.
AU - Colibaseanu, Dorin T.
AU - Vizzini, Michael R.
AU - Roy, Vivek
AU - Colon-Otero, Gerardo
AU - Chanan-Khan, Asher A.
N1 - Publisher Copyright:
© 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
PY - 2017/12
Y1 - 2017/12
N2 - Outcomes have improved considerably in multiple myeloma (MM), but disparities among racial-ethnic groups exist. Differences in utilization of novel therapeutics are likely contributing factors. We explored such differences from the SEER-Medicare database. A utilization analysis of lenalidomide, thalidomide, bortezomib, and stem cell transplant (SCT) was performed for patients diagnosed with MM between 2007 and 2009, including use over time, use by race, time-dependent trends for each racial subgroup, and survival analysis. A total of 5338 MM patients were included with median 2.4-year follow-up. Within the first year of MM diagnosis, utilization of lenalidomide, bortezomib, SCT, and more than one novel agent increased over time while utilization of thalidomide decreased. There was significantly lower utilization of lenalidomide among African-Americans (P < 0.01), higher thalidomide use among Hispanics and Asians (P < 0.01), and lower bortezomib use among Asians (P < 0.01). Hispanics had the highest median number of days to first dose of bortezomib (P = 0.02) and the lowest utilization of SCT (P < 0.01). Hispanics and Asians were the only groups without notable increases in lenalidomide and bortezomib use, respectively. SCT utilization increased over time for all except African-Americans. SCT use within the first year after diagnosis was associated with better overall survival (HR 0.52; 95% CI: 0.4–0.68), while bortezomib use was associated with inferior survival (HR 1.14; 95% CI 1.02–1.28). We noted considerable variability in MM therapeutics utilization with seeming inequity for racial-ethnic minorities. These trends should be considered to eliminate drug access and utilization disparities and achieve equitable benefit of therapeutic advances across all races.
AB - Outcomes have improved considerably in multiple myeloma (MM), but disparities among racial-ethnic groups exist. Differences in utilization of novel therapeutics are likely contributing factors. We explored such differences from the SEER-Medicare database. A utilization analysis of lenalidomide, thalidomide, bortezomib, and stem cell transplant (SCT) was performed for patients diagnosed with MM between 2007 and 2009, including use over time, use by race, time-dependent trends for each racial subgroup, and survival analysis. A total of 5338 MM patients were included with median 2.4-year follow-up. Within the first year of MM diagnosis, utilization of lenalidomide, bortezomib, SCT, and more than one novel agent increased over time while utilization of thalidomide decreased. There was significantly lower utilization of lenalidomide among African-Americans (P < 0.01), higher thalidomide use among Hispanics and Asians (P < 0.01), and lower bortezomib use among Asians (P < 0.01). Hispanics had the highest median number of days to first dose of bortezomib (P = 0.02) and the lowest utilization of SCT (P < 0.01). Hispanics and Asians were the only groups without notable increases in lenalidomide and bortezomib use, respectively. SCT utilization increased over time for all except African-Americans. SCT use within the first year after diagnosis was associated with better overall survival (HR 0.52; 95% CI: 0.4–0.68), while bortezomib use was associated with inferior survival (HR 1.14; 95% CI 1.02–1.28). We noted considerable variability in MM therapeutics utilization with seeming inequity for racial-ethnic minorities. These trends should be considered to eliminate drug access and utilization disparities and achieve equitable benefit of therapeutic advances across all races.
KW - Cancer management
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U2 - 10.1002/cam4.1246
DO - 10.1002/cam4.1246
M3 - Article
C2 - 29105343
AN - SCOPUS:85032917189
SN - 2045-7634
VL - 6
SP - 2876
EP - 2885
JO - Cancer medicine
JF - Cancer medicine
IS - 12
ER -