The American Journal of Managed Care convened a panel of experts to discuss advances and challenges in treating multiple myeloma, which has seen longer survival rates since the arrival of bortezomib and thalidomide.
Published Online: June 03, 2014
PLAINSBORO, N.J. – It’s a concern that only comes when cancer therapy succeeds: As the length of survival for the typical multiple myeloma patient has nearly tripled, the number of patients living with the disease has also increased. Today, a cancer that was once a blip on the radar screen for insurers is slowly catching their attention as the cost of care increases, both for individual patients and gradually, across payment systems.
The American Journal of Managed Care
recently convened a panel that included clinicians and representatives from the payer community and the Multiple Myeloma Research Foundation (MMRF). The group discussed advances and challenges in diagnosis, treatment, and the cost of care for patients who have this still relatively uncommon blood cancer. Joining moderator and AJMC
co-editor-in-chief Michael Chernew, PhD,
were Shaji K. Kumar, MD
, Professor of Medicine, Mayo Clinic; Jack Goldberg, MD,
Clinical Professor of Medicine, Penn Presbyterian Medical Center; Gene Reeder, Rph, PhD
, Director, Managed Care Networks, Xcenda; and Anne Quinn Young, MPH,
Vice President, Development and Strategic Partnerships, MMRF. To listen to the full discussion, click here.
About 24,000 new patients will be diagnosed in the United States in 2014, according to the MMRF. Over the past two decades, advances such as the use of bortezomib and thalidomide, alongside stem cell transplants, have revolutionized care and increased average survival from three years to eight. As Dr. Goldberg explained, as newer drugs have come on line, they have been less toxic, allowing patients to be treated for longer periods and achieving a “deeper” response. “That’s where the benefit has been seen the most,” he said.
And doctors are learning that multiple myeloma cannot be treated with a “hit and run” strategy, said Dr. Kumar. “Patients need a couple of years’ worth of therapy, or even more,” he said. “This is dictated by the underlying biology,” although there may be periods when patients can go off therapy.
The evolution of multiple myeloma from hard-to-treat blood cancer to a chronic disease means that it will likely be expensive to treat, Dr. Goldberg said, although this may be offset by more years of productivity and quality of life. Dr. Kumar noted that some of the drugs that treat the disease will soon come off patent, which will mitigate costs somewhat. But the clinicians explained that the complexity of the disease, which manifests itself differently from patient to patient, means that treatment will always be very individualized, and that many patients will be on multiple drugs at once.
Both Drs. Goldberg and Kumar said that thus far, insurers have largely not balked at paying for multiple myeloma therapies, with the possible exception of oral therapies. But they said that could change as monoclonal antibodies near approval, and the variety of available options increases.
“The insurer market is concerned about all these things,” said Dr. Reeder. While it’s clear that patients have benefited, he said, payers will be interested in reaching a point of determining which patients will benefit from which therapy, and establishing a “stopping rule” to handle requests to repeat therapies that have already failed.
Quinn Young said that MMRF’s CoMMpass study, which is gathering genetic information from 1,000 patients from a variety of treatment settings, aims to share results with researchers and clinicians alike. This will aid decision-making on treatment, thus taking the guesswork and, in time, some costs out of treatment decisions. For some patients at least, less expensive drugs, or fewer drugs, may be enough, she said.
Said Dr. Goldberg, “We have to figure out how to do the best job in the beginning.”
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About the Journal
The American Journal of Managed Care
, now in its 20th
year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. In December 2013, AJMC
launched The American Journal of Accountable Care,
which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC
’s news publications, the Evidence-Based
series, bring together stakeholder views from payers, providers, policy makers and pharmaceutical leaders in the areas of oncology, diabetes management, respiratory care, and immunology and infectious disease. For more, click here
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