Expenditure on Medicines for the Treatment of Multiple Myeloma in Catalonia for 2021

OBJECTIVES: To analyze the annual expenditure in 2021 of medicines for the treatment of multiple myeloma (MM) in the public health system hospitals of Catalonia.

METHODS: A retrospective cohort study of patients treated with hospital outpatient drugs (HOD) for MM in Catalonia in 2021 was carried out. From the Registry of Patients and Treatments, a clinical-practice database, information on patient demographics and pharmacological treatment was collected about patients treated for MM with Bortezomib, Carfilzomib, Daratumumab, Lenalidomide or Pomalidomide. Treatments cost was analyzed based on billing data from the Catalan Health Service.

RESULTS: Pharmacological treatments for MM were prescribed to 1,489 patients (mean [SD] age 70.3 [11.0] years, 50% women), 3.7% of the all cancer patients and 0.6% of those receiving HOD. The overall 2021 expenditure on MM was €56.8 million, 13.0% of the expenditure on cancer drugs and 4.5% on HOD. Annual cost per patient was €38,117. Highest expenditure and largest number of patients was in second line therapy with €16.3 million (29% overall) for 493 (33% overall) patients. However, with an average of €81,829, first line treatments for non-eligible patients for hematopoietic stem cell transplantation had the highest cost/patient. Lenalidomide was the drug prescribed to most patients (N=1,093; 73% overall) and with the highest expenditure (€30.4M; 54% overall). Daratumumab (N=418; 28%; cost €14.8M; 26%) had the highest cost/patient, with an average of €35,348 for all lines.

CONCLUSIONS: The investment of the Catalan public health system in the pharmacological treatment of MM represents a significant proportion of the total expenditure in HOD, much higher and not correlated with the proportion of patients. Moreover, almost 80% of this expenditure is attributable exclusively to two of the analyzed drugs: Lenalidomide and Daratumumab. Further analysis about combination of drugs and health-related outcomes are necessary to evaluate the current efficiency of MM treatments.