OBJECTIVES: The introduction of new pharmacological treatments for multiple myeloma (MM) has improved overall survival, progression-free survival and response rates, however most patients will suffer multiple relapses. The study objective was to review the published evidence on the economic/social burden of relapsed or refractory MM (RRMM).

METHODS: A systematic review of the literature, without language or geographical restrictions, was carried out in PubMed and Embase, following PRISMA guidelines. Studies with full text available, in patients with RRMM, containing information on the economic or social burden of the disease, published between 01/01/2013 and 31/12/2017 were included. Key characteristics, methods and results of the selected studies were extracted and analyzed critically.

RESULTS: The search identified 36 full-text studies on the economic/social burden of RRMM. Pharmacologic costs represent 77% and 80% of the total costs of the disease in the EU and USA, respectively. These costs were considerably higher than costs for first-line treatment. Other direct costs (outpatient/day treatment visits and intensive care) seem similar per line of therapy except for inpatient days, which were shown to be higher in the third-line. RRMM worsens quality of life, sleep quality, depression, anxiety and bone pain, with first relapse having a particularly marked emotional impact on patients. The new treatment schemes would generate gains in quality-adjusted life years (QALYs) and improvements in disease symptoms compared with current treatment schemes. This improvement would be more evident in first-line patients, with less clinically meaningful changes in QoL scores happening in RRMM. The use of oral treatments would imply more satisfaction for the patients and lower costs for the healthcare systems.

CONCLUSIONS: The treatment of RRMM entails a considerable economic and social burden. Study results suggest that delaying the first remission would improve outcomes and reduce disease costs.