Healthcare resource utilization and costs among multiple myeloma patients with double- or triple-class exposure: a retrospective U.S. claims database analysis

Abstract

Background: Despite recent advancements in the therapeutic landscape, MM remains incurable, and most patients require several lines of therapies (LOTs). The lack of treatment options for these patients has prompted the development of new targeted therapies with novel mechanisms. Currently, there is limited evidence describing the economic burden among MM patients exposed to different drug classes and combinations and across different healthcare settings. Objective: To describe all-cause and MM-related HCRU and costs among MM patients exposed to different drug classes and combinations (e.g., double- and triple-class exposed) and characterize all-cause and MM-related healthcare costs incurred in different healthcare settings among these MM patients. Methods: We conducted a retrospective cohort study using administrative claims data from the IBM® MarketScan® Commercial and Medicare Supplemental databases. The study included adult patients (≥18 years) diagnosed with MM between December 1st, 2015 and December 31st, 2019. The study sample comprised double-class exposed (DCE) and triple-class exposed (TCE) cohorts, categorized based on their earliest exposures to different combinations of immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), or targeted monoclonal antibody (mAbs). Only patients with ≥ 1 subsequent LOT following the categorization were included, and the start date of the first subsequent LOT was the index date. The primary outcomes of interest were all-cause and MM-related healthcare resource utilization (HCRU) and costs during the follow-up period. We categorized eight different care settings associated with the study sample using the place of service code variable. The total all-cause and MM-related costs incurred by patients in each setting were reported. The Kaplan-Meier sample average (KMSA) technique was used to estimate the cumulative mean outcomes, accounting for differential follow-up periods, and the outcomes were reported as per patient per month (PPPM). Results: The study included 1,521 MM patients, of which 1,016 (66.8%) patients were DCE and 505 (33.2%) were TCE. Using the estimates from the KMSA, the mean PPPM total all-cause healthcare costs were $20,338 PPPM, and approximately 85% of the total all-cause costs were MM-related. The mean total all-cause and MM-related total costs were driven by overall drug costs, primarily attributed to MM treatment and administration costs. When stratified by the class-exposure status, the TCE cohort was associated with higher HCRU and incurred higher costs than the DCE cohort across all categories. The hospital-based ambulatory setting was the highest cost setting during the follow-up period, with the mean total all-cause and MM-related costs of $7,302 (95% CI: $6,801-$7,784) PPPM and $6,695 (95% CI: $6,239-$7,136) PPPM, respectively. Conclusion: The findings of this study suggest that the economic burden following exposure to multiple drug classes and combinations is substantial, especially among the TCE cohort compared to the DCE cohort and in the ambulatory setting. Total costs incurred by these patients were primarily MM-related and mainly attributable to MM drug and administration costs. These findings highlight the need for more effective treatments that can mitigate the resource use and economic burden in the management of MM. Future research on the HCRU and costs incurred after the exposure to recently approved MM treatments with novel mechanisms is warranted.