title: Management of relapsed or refractory multiple myeloma in French hospitals and estimation of associated direct costs: a multi-centre retrospective cohort study.
abstract: BACKGROUND
  For relapsed or refractory multiple myeloma (RRMM), a series of novel agents (thalidomide, bortezomib and lenalidomide) has emerged during the latest decade, but their use in routine clinical practice is not well documented as well as the cost of RRMM.
  
  
  OBJECTIVE
  Our aim is to review the therapeutic management of such patients in France and to estimate the associated costs.
  
  
  METHODS
  A retrospective cohort study, based on chart reviews, was conducted in French Haematology Departments over the period 2004-2007 and the associated direct costs estimated.
  
  
  RESULTS
  One hundred and two patients with a relapse after first-line therapy were selected from five centres. The average follow-up from diagnosis or the date of first relapse to death or to the latest news was respectively 56.25 and 23.53 months. Novel agents were used in 73% of all cases, and in all cases of first relapse. Thalidomide and bortezomib were respectively the most frequently used second-line (57%) and third-line treatments (44%). The average number of lines of treatment received per patient as from first relapse was 2.75 (min 1; max 8) and the mean direct cost per month was estimated at 3130 € after the first relapse. This cost was represented in greater part by the cost of chemotherapy drugs (66%).
  
  
  CONCLUSIONS
  The use of novel agents such as thalidomide, bortezomib and lenalidomide for RRMM is highly prevalent in France from the first relapse. The associated medical cost is substantial mainly due to the cost of the new agents.
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Pharmacy Department/Délégation à la Recherche Clinique et à l'Innovation, Cellule Innovation, Bron, France. xavier.armoiry@chu-lyon.fr
authors.forename: X
authors.initials: X
authors.lastname: Armoiry
authors.forename: F
authors.initials: F
authors.lastname: Fagnani
authors.forename: L
authors.initials: L
authors.lastname: Benboubker
authors.forename: T
authors.initials: T
authors.lastname: Facon
authors.forename: J P
authors.initials: JP
authors.lastname: Fermand
authors.forename: C
authors.initials: C
authors.lastname: Hulin
authors.forename: P
authors.initials: P
authors.lastname: Moreau
authors.forename: G
authors.initials: G
authors.lastname: Aulagner
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D001897:Boronic Acids / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000069286:Bortezomib; D015331:Cohort Studies; D016527:Drug Costs / Q000706:statistics & numerical data; D019008:Drug Resistance, Neoplasm; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011719:Pyrazines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide