Among patients with multiple myeloma treated with older proteasome inhibitors, those who developed peripheral neuropathy (PN) had significantly higher costs, suggesting that newer therapies may maintain effective treatment while lowering the economic and disease burden of PN in these patients.
Peripheral neuropathy (PN) is a common adverse event associated with multiple myeloma (MM) when treated with older-generation proteasome inhibitors. In addition to impacting quality of life for patients, the complication is also associated with an added cost burden, according to a new study.
Drawing on 10 years’ worth of data, researchers found that patients with MM who developed PN had costs that were $1509 higher per month compared with patients with MM who did not develop the complication, amounting to $36,216 over 2 years of follow-up.
“This difference was primarily attributable to the first 180 days postindex where PN patients’ mean per patient per month costs exceeded those of the non-PN cohort by $3317 during the first 90 days and by $5167 during the period 91-180 days postindex,” wrote the researchers.
Costs were significantly higher for patients with PN during the first line of therapy ($23,183 vs $20,790) and second line of therapy ($37,880 vs $29,694).
The researchers relied on administrative health claims data from January 1, 2006, through February 28, 2017, from both commercial and Medicare databases, which included inpatient medical, outpatient medical, and outpatient pharmacy claims data, as well as patient demographics. Throughout the study period, the researchers followed 3981 patients with MM, 1387 of whom had PN. At baseline, 50% to 53% of patients were receiving bortezomib, 37% to 38% were receiving lenalidomide, 10% were receiving cyclophosphamide, and 5% to 6% were receiving thalidomide as initial MM treatment.
The increased costs associated with PN were driven by more healthcare utilization per patient per month. Patients with PN were more likely to be hospitalized during follow-up compared with patients without PN (77.4% vs 67.2%), although the length of stay between the 2 groups was similar (0.60 days vs 0.66 days).
Patients with PN also had higher rates of emergency department visits (67.8% vs 58.4%), more outpatient hospital-based visits (13.5 vs 11.5), and more outpatient prescriptions (4.7 vs 4.2). Meanwhile, patients with PN had fewer laboratory tests (4.1 vs 4.7).
“Obtaining optimal clinical efficacy requires carefully balancing treatment effectiveness with the potential for negative consequences on the patient’s quality of life,” wrote the researchers. “The dosage reductions, treatment switches, or discontinuation of MM therapies to manage PN may ultimately affect response to therapy.”
As thalidomide and bortezomib have been associated with higher rates of PN, the researchers argue that recent approvals of new therapies, such as carfilzomib, may hold promise for effectively treating MM while easing both the disease and economic burdens associated with PN.
Song X, Wilson K, Kagan J, Panjabi S. Cost of peripheral neuropathy in patients receiving treatment for multiple myeloma: a US administrative claims analysis [published online April 1, 2019]. Ther Adv Hematol. doi: 10.1177/2040620719839025.