Quantifying the Burden of Multiple Myeloma Across Europe
Authors: Schey Stephen A , Morris James , Maguire Áine , Dhanasiri Sujith 
Published: November 2019

Abstract
Background: In recent years there has been an increasing focus on the costs of managing patients with Multiple Myeloma (MM). Novel agents such as immunomodulators and proteasome inhibitors have been added into the treatment pathway alongside conventional management options including intensive chemotherapy, stem cell transplantation, and supportive care. Commissioners of healthcare have evaluated these additional costs in the context of clinical outcomes such as response rates, progression free survival and overall survival. However, relatively little attention has been paid to disease burden which we argue is an important dimension alongside costs and outcomes.
Objective:To estimate the burden of disease associated with MM in the European Union.
Methods: A literature review was undertaken to identify assessments of disease burden in MM. A de novo analysis was undertaken to quantify disease burden across the European Union, using Disability Adjusted Life Years (DALYs). DALYs represent the sum of Years of Life Lost (YLL) due to premature mortality and the Years Lost due to Disability (YLD) for a condition. We use long-term projections for incidence, mortality, and life expectancy to estimate DALYs in 5 year intervals out to 2030. Finally, we ran a hypothetical scenario to explore the impact of potential improvements in treatment outcomes.
Results: Across the European Union we estimate a total of over 175,000 DALYs for 2015 attributable to MM; which is equivalent to more than 34.5 DALYs per 100,000 population. Disease burden appears to vary considerably by country, partly as a function of incidence rates. For the EU as a whole, MM incidence is projected to increase from approximately 35k new cases to over 43k by 2030. Over the same time period, deaths due to MM are projected to increase from 21.5k to over 27k. Using data from Eurostat and Globocan, we estimate that DALYs for MM in the EU will increase from 175k to approaching 290k by 2030. In terms of DALYs per 100,000 population, this represents a more than 60% projected increase from 34.4 to 55.6 DALYs per 100,000. In our hypothetical scenario, a 1-year increase in overall survival reduced the number of DALYs in the EU by 16,000 for 2020 and by 19,000 for 2030.
Discussion: Incorporation of new treatments in the management of myeloma in the last decade has helped improve the median survival of patients. However, as population life expectancy increases, incidence of MM and associated disability is expected to increase substantially. New treatments represent a significant opportunity to reduce this burden. We estimate that a 1-year increase in life expectancy for MM patients would be associated with a 7% reduction in DALYs. Further research is required to confirm DALY estimates in MM but we argue that DALYs provide a useful metric for healthcare commissioners.

Disclosures
Schey: Celgene, Takeda: Honoraria; Celgene, Johnson & Johnson: Speakers Bureau; Celgene: Consultancy. Morris:Cogentia UK: Research Funding. Maguire:Cogentia UK: Research Funding. Dhanasiri:Celgene: Employment, Equity Ownership.