OBJECTIVES:

Bortezomib and carfilzomib treatments for multiple myeloma (MM) require drug administration visits at hospital. Commonly, an escort (e.g. caregiver, relative, friend) accompanies patient during such hospital outpatient visit. These outpatient visits occur frequently, but patient’s or escort’s productivity costs (PCs) related to these visits have not been published. PCs are important for both individual and societal perspectives and relevant for burden of illness or cost-effectiveness analyses. This study estimated potential absenteeism-based PCs related to bortezomib and carfilzomib administration in Finland.

METHODS:

PCs were estimated conservatively based on time lost due to drug administration during outpatient visit. Number of visits and their lengths per treatment cycle were defined based on treatment protocols and local practices. Cycles of three weeks and four administrations for bortezomib, and four weeks and six administrations for carfilzomib were used. Travel times to and from hospital were estimated based on the results of a spatial health care accessibility analysis with 1x1km population density resolution, location of university and central hospitals, and the geometry of the road and street network in Finland.

RESULTS:

PCs per employed patient were 91€/visit and 337€/cycle for bortezomib, and 146€/visit and 882€/cycle for carfilzomib. When considering the employment rate of MM patients, average patient’s PCs were 31€/visit and 126€/cycle for bortezomib, and 50€/visit and 302€/cycle for carfilzomib. With escort’s PCs included, average PCs increased to 50€/visit and 201€/cycle for bortezomib, and 81€/visit and 484€/cycle for carfilzomib. PCs per person attributable to travelling were 28€/visit.

CONCLUSIONS:

PCs related to bortezomib and carfilzomib administration for MM were estimated to be significant. In addition, travelling time to and from hospital forms a significant proportion of total PCs, at least in sparsely populated areas such as Finland. Therefore, novel oral medications including ixazomib have significant potential in reducing absenteeism-based PCs during the treatment of MM.