OBJECTIVES

: Novel drugs are dynamically changing treatment for multiple myeloma (MM), have improved prognosis in clinical studies but are expensive. This study assessed real-world application and costs.

METHODS

: Retrospective observational cohort analysis (2012-2017) in a claims database of a major Swiss health insurance company (population coverage: 14%). We used primary (ICD-10 diagnoses) and secondary features (prescribed MM-specific drugs) as inclusion criteria and defined a hierarchy of drug regimens: 1) proteasome inhibitor (PI)-based (e.g. bortezomib); 2) IMID-based (e.g. lenalidomide); 3) chemotherapy (CHEMO)-based (e.g. bendamustin); 4) monoclonal antibody (MAB)-based (e.g. daratunumab). Direct medical costs of mandatory health insurance were analysed in 2017 Swiss Francs (CHF; third party payer perspective).

RESULTS

: We identified n=1054 prevalent MM patients (2012-2017) and n=378 incident MM patients (2015-2017; 47% men). The annual number of prevalent patients increased over time (from n=314 to n=645). PI-based regimens were the most frequent first line approach (76.0%), followed by IMID-based (21.9%) and CHEMO-based (2.1%). For later lines, IMID-based regimens were most often used (2^nd line: 56.4%; 3^rd line: 2 of 3 patients), followed by PI-based (43.6% and 1 of 3 patients, respectively). 15.3% of prevalent patients were treated with autologous hematopoietic stem cell transplantation. Costs per treatment line varied between CHF 81’352 (PI-based) and CHF 73’495 (IMID-based). Mean daily costs under MM treatment stepwise increased from CHF 209 to CHF 254 (relative increase: 21.5%). Annual direct medical costs in Switzerland for seven novel MM drugs were extrapolated to be 60.1 Mio CHF in 2012 and 118.6 Mio CHF in 2017 (relative increase: 97.3%). Annual death rates decreased from 18.6% to 15.5% (risk ratio: 0.83; 95%-CI: 0.63 to 1.10; p for trend: 0.03).

CONCLUSIONS

: An increasing prevalent population of MM patients in combination with increasing costs per day under treatment lead to a growing budget impact for the Swiss social insurance system.