Economic and Social Burden of Multiple Myeloma in Italy: The Co.Mi.M. Study
Authors: Petrucci Maria Teresa , Calabrese Elisabetta , Levi Anna , Federico Vincenzo , Ceccolini Michela , Rizzi Rita , Gozzetti Alessandro , Falco Patrizia , Cavallo Maria Caterina , Gerzelli Simone , Boccadoro Mario , Lauria Francesco , Liso Vincenzo , Cavo Michele , Foa Robert 
Published: April 2020

Abstract
Background. Few data are available on the impact of multiple myeloma (MM) on Italian healthcare expenditure and society broadly. This is especially important because of the increased prevalence of MM in Italy.
Aim and methods. The Co.Mi.M. study is a cross-sectional retrospective, prevalence-based study (Tarricone, Health Policy, 2006) that involved 5 Italian hematologic institutions and designed to measure resource utilization associated with MM management in terms of direct and indirect costs in a societal perspective. A specific questionnaire was administered to obtain anonymous, subject-level data on health-care utilization and costs in 236 subjects with MM. Quality of Life (QoL) data collection was included in the protocol. Data sources included clinical records and interviews with physicians and patients. Four disease-phases were considered in a stratified distribution that reflects real clinical practice:
asymptomatic (“watch and wait”); symptomatic, receiving an autotransplant; symptomatic, receiving drugs; and plateau/remission.
Costs were identified over 1 year of disease management with regard to:
drugs; visits; laboratory tests; hospital admissions; support devices; home assistance; travel; and reduced productivity of patients and caregivers.
Costs for lost working days were derived according to the human capital method using national average earnings per working category. No clinical outcomes were collected. Health-related QoL was measured using the EORTC QLQ-C30.
Results. The sample distribution was as follows:
16.5% asymptomatic; 12.3% symptomatic, receiving an autotransplant; 44.5% symptomatic, receiving drugs; and 26.7% plateau/remission.
The average social costs per subject per year were €20,868. Direct health-care costs (hospitalizations, drugs, diagnostics, visits, etc) were €16,867 per subject per year; direct non-health care costs (transportation, hotels, paid care, etc.) were €1,776 per patient per year; indirect costs (productivity loss) were €2,225 per subject per year.
The average direct health care costs per subject per year in the different subgroups were:
€755, €53,102; €18,882; €6,803.
The groups with the highest resource utilization were (b) the autotransplanted and (c) those receiving drugs. Specifically, 95% of total hospitalizations were related to autotransplant.
Conclusion. The main resource utilization comes for direct medical costs. MM treatment strategy has changed dramatically in the last years. In particular, transplant and pharmacological treatments represent the most relevant costs, although counterbalanced by the highly increased clinical outcomes reported in the literature. After year 2000 the post-relapse survival has steadily improved. In particular, an improvement in survival amongst patients who had access to one or more innovative drugs has been demonstrated (Shaji Kumar, Blood, 2007).