Frequency, Health Care Resource Use (HCRU), and Costs Associated With Skeletal Related Events (SREs) In US Patients With Multiple Myeloma (MM)
Authors: Nash Smyth Emily , Conti Ilaria , Wooldridge James , Bowman Lee , Li Li , Nelson David , Xie Jin , Ball Daniel E 
Published: October 2019

Abstract

Background
Existing data demonstrate that SREs can impose a significant economic burden. Much of the cost data for MM patients are combined with other tumor types and do not make comparisons between MM patients with SRE and MM patients without SRE. This research provides updated, comprehensive cost data in MM patients to address these gaps.

Methods
Patients 18 years of age or older were required to have ≥2 claims in any position with a diagnosis of MM (ICD-9-CM codes 203.00, 203.01, 203.02), at least 30 days apart, between 01 January 2005 and 31 December 2010; the date of the first MM diagnosis was the index date. Marketscan(r) data were used to select patients continuously enrolled in a non-capitated commercial health plan with a medical and pharmacy benefit for 12 months before the index date (i.e., baseline period) and at least 3 months after the index date (post-index period). Patients were followed until the earliest of death or disenrollment from the health plan or end of the study period on 31 December 2011. MM patients with ≥ 1 SRE were compared to those without SRE to characterize the associated incremental cost of SRE. Frequency of SREs, HCRU (events/person-mth), and costs (USD/person-mth) were determined. Cost is defined as total gross payment to providers for a specific service, which includes amount paid by the patient and payer. Due to skewed distributions, bootstrapping (replication=1000) methodology was used to estimate standard error of rates of HCRU and costs and to compare cohorts. P-values were generated utilizing 2-sample t-tests.

Results
MM patients with SRE (n=596, mean age=67.8, 45.6 % male, mean Charlson/Deyo [CD] =1.1) were compared to MM patients without SRE (n=432, mean age=65.7, 47.5 % male, mean CD=0.8). Patients are categorized by number of SREs experienced during the study period in Table 1. MM patients with SRE experienced significantly greater HCRU during both the baseline and post-index periods (Tables 2&3). The HCRU increases translated into mean total costs for patients with SRE that were significantly greater during both the baseline (w/o SRE: USD 953; w/SRE: USD 1328; p=0.005) and post-index (w/o SRE: USD 3307; w/SRE: USD 4763; p<0.0001) periods. Increasing frequency of SRE was significantly associated with increasing trend of HCRU and cost throughout the study (all p values <0.0001).

Conclusion
In addition to the clinical burden, SREs significantly add to the economic burden associated with MM in US patients by increasing the rate of HCRU and cost.

Disclosures:
Smyth: Eli Lilly and Company: Employment, Equity Ownership. Off Label Use: The frequency of bisphosphonate use (both oral and IV) will be described in the poster. Conti:Eli Lilly and Company: Employment, Equity Ownership. Wooldridge:Eli Lilly and Company: Employment, Equity Ownership. Bowman:Eli Lilly and Company: Employment, Equity Ownership. Li:Eli Lilly and Company: Employment, Equity Ownership. Nelson:Eli Lilly and Company: Employment. Xie:Eli Lilly and Company: Employment, Equity Ownership. Ball:Eli Lilly and Company: Employment, Equity Ownership.