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Second Line Therapy in Multiple Myeloma: A SEER Medicare Analysis
Matthew R LeBlanc1, Xi Zhou2, Christopher D Baggett2
1University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
Introduction:
The therapeutic landscape in relapsed/refractory multiple myeloma (RRMM) has changed rapidly, with twenty-two drug approvals since 2012. We characterized population-level trends in RRMM therapy selection, survival and cost outcomes associated with RRMM treatment over time.
Materials And Methods:
Our cohort included adults diagnosed with multiple myeloma (MM) in the SEER-Medicare database from 2007-2017 who received at least one antimyeloma agent. MM-directed therapies and lines of therapy were identified. Changes in 2LT regimens over time were described. Trends in overall survival from 2LT initiation over time were analyzed using a Cox proportional hazards model adjusting for factors associated with survival in MM. Trends in mean inflation-adjusted cost per 12 months of 2LT were analyzed using JoinPoint analysis.
Results:
A total of 9,822 patients met eligibility criteria, of whom 5,866 (59.7%) received 2LT. By 2018, 46% of 2LT regimens contained at least one agent approved in 2012 or later. Year of 2LT initiation was associated with improved overall survival (HR 0.78 per 5 years, 95% CI 0.74-0.84) after adjustment. Costs associated with 2LT increased over the study period, and the rate of cost increase increased significantly after 2012 (0.89%/year vs. 9.9%/year, P < .001), with higher total costs for regimens containing newer novel agents (mean $224,193 vs. $189,381, P < .001) CONCLUSION: Overall survival after initiation of 2LT has improved, however this has been accompanied by significant increases in costs of RRMM treatment, particularly for patients receiving newer novel agents. These findings provide useful context for existing and future drug approvals in RRMM.
Insights
Improved survival in relapsed/refractory multiple myeloma (RRMM) treatment is linked to rising costs. Newer therapies offer better outcomes but significantly increase healthcare expenses for RRMM patients.
Area of Science:
- Hematology
- Oncology
- Health Economics
Background:
- The treatment landscape for relapsed/refractory multiple myeloma (RRMM) has evolved significantly with numerous drug approvals since 2012.
- Characterizing population-level trends in therapy selection, survival, and cost is crucial for understanding treatment evolution.
Purpose of the Study:
- To analyze trends in therapy selection, overall survival, and costs for patients with relapsed/refractory multiple myeloma.
- To evaluate the impact of newer therapies on treatment outcomes and healthcare expenditures over time.
Main Methods:
- Utilized the SEER-Medicare database (2007-2017) including 9,822 adult patients with multiple myeloma (MM).
- Identified MM-directed therapies and lines of therapy, focusing on second-line therapy (2LT) regimens.
- Analyzed overall survival trends using Cox proportional hazards models and cost trends using JoinPoint analysis.
Main Results:
- Nearly 60% of patients received 2LT, with 46% of 2LT regimens including agents approved after 2012 by 2018.
- Initiation of 2LT in later years was associated with improved overall survival (HR 0.78 per 5 years).
- Mean inflation-adjusted costs for 2LT increased significantly post-2012, with higher costs for regimens containing novel agents ($224,193 vs. $189,381).
Conclusions:
- Overall survival has improved for RRMM patients initiating second-line therapy.
- This survival improvement is accompanied by substantial increases in treatment costs, particularly with novel agents.
- Findings provide essential context for evaluating current and future drug approvals in RRMM management.
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