title: Real-world health care costs of relapsed/refractory multiple myeloma during the era of novel cancer agents.
abstract: OBJECTIVE
  High costs of novel agents increasingly put pressure on limited healthcare budgets. Demonstration of their real-world costs and cost-effectiveness is often required for reimbursement. However, few published economic evaluations of novel agents for multiple myeloma exist. Moreover, existing cost analyses were heavily based on conventionally treated patients. We investigated real-world health care costs of relapsed/refractory multiple myeloma in Dutch daily practice.
  
  
  METHODS
  A retrospective medical chart review was conducted for 139 patients treated between January 2001 and May 2009. Total monthly costs attributable to each cost component were described across all regimens and for bortezomib-, thalidomide- and lenalidomide-based treatment regimens.
  
  
  RESULTS
  Mean monthly total costs (€3,981) varied depending on the sequence of therapy (range: €442-€31,318). Significant cost drivers across all regimens included costs of therapy and hospital admissions. The acquisition costs for novel agents in particular accounted for 32% of mean total monthly costs. Prognostic factors associated with increased mean total monthly costs in multivariate regression analysis included low platelet counts (P = 0·01) and worsening performance status (P < 0·001). Mean total monthly costs of bortezomib- and lenalidomide-based regimens were significantly higher than those for thalidomide-based regimens in second, third and fourth treatment line.
  
  
  CONCLUSIONS
  Real-world costs during treatment of relapsed/refractory multiple myeloma vary greatly. Cost drivers include hospital admissions and acquisition costs of novel agents. Costs also vary by prognostic factors and treatment-related resource use. Future studies assessing the costs of combination therapy consisting of two or more novel agents are encouraged.
authors.affiliation: Institute for Medical Technology Assessment/Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. gaultney@bmg.eur.nl
authors.forename: J G
authors.initials: JG
authors.lastname: Gaultney
authors.forename: M G
authors.initials: MG
authors.lastname: Franken
authors.forename: S S
authors.initials: SS
authors.lastname: Tan
authors.forename: W K
authors.initials: WK
authors.lastname: Redekop
authors.forename: P C
authors.initials: PC
authors.lastname: Huijgens
authors.forename: P
authors.initials: P
authors.lastname: Sonneveld
authors.forename: C A
authors.initials: CA
authors.lastname: Uyl-de Groot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D017326:Clinical Trials, Phase III as Topic; D016527:Drug Costs; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D000077269:Lenalidomide; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D015999:Multivariate Analysis; D009426:Netherlands; D011379:Prognosis; D011719:Pyrazines / Q000008:administration & dosage; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide