OBJECTIVES

In the context of a fast-changing therapeutic landscape in multiple myeloma (MM), this study describes the evolution from 2014 to 2019 of the MM economic burden in France by treatment lines.

METHODS

This is a retrospective cohort study of MM patients based on SNDS data, the French National Health Insurance databases. MM patients were identified using a published algorithm refined to consider recent evolutions of MM therapeutic management and treatment lines were re-constructed through ATLAS, an adaptation of the Smith-Waterman alignment sequence using artificial intelligence. Costs were estimated with the partitioned Bang and Tsiatis method to consider censoring.

RESULTS

40,747 MM patients were identified from 2014 to 2019. Treatment lines were re-constructed for 36,241 of them with 49,310 different lines identified: 5,286 L1 with transplant (L1 TE), 17,856 L1 without transplant (L1 NTE), 13,525 L2, 7,885 L3 and 4,758 L4+. For patients who initiated a treatment line in 2017, the average estimated total cost was 117,965€ for L1 TE, 75,560€ for L1 NTE, 90,562€ for L2, 100,693€ for L3 and 187,654€ for L4+. The distribution of average costs for patients who initiated a L1 NTE in 2017 was: 37,905€ for medications; 25,487€ for hospital care; 3,898€ for consultations; 2,999€ for lab tests, medical devices or medical procedures outside the hospital; 1,304€ for daily fees, pensions or other allocations compensation revenue; 3,299€ for transportation and 669€ for other care outside the hospital. In 2017, the proportion of costs related to medications received both in and outside the hospital was lower for L1 TE (39%) than for L1 NTE (50%), L2 (66%), L3 (69%), and L4+ (71%).

CONCLUSIONS

The economic burden of MM varies depending on MM treatment lines. Overall, the highest types of consumption are medications, but other costs, especially related to hospital cares are not negligeable.