Components of Health Care Expenses Associated with Multiple Myeloma: An Analysis of US Claims Database
Authors: Hu X Henry , Cai John , Binder Gary , Monzini Mara Silvia , Nagarwala Yasir 
Published: October 2019

Abstract
Introduction: Multiple myeloma (MM) is an incurable hematologic malignancy. Due to the introduction of newer MM treatments, patient survival has increased and outcomes have improved over the last 10 years, but not without questions arising regarding the overall cost of care of these patients. Recent studies suggest that medical (nondrug) costs account for the majority of the total expenses of relapsed MM treatment (Gaultney 2013). This study seeks to describe the nature of resource utilization in patients with newly-diagnosed MM based upon real-world data from a US claims database.
Methods:We investigated the total health care cost for patients over the first 2 years after initial diagnosis by analyzing a commercial claims database containing anonymized health data from ~20 million individuals, including prescription drugs and clinical use and costs across inpatient and outpatient services. The study population included all patients diagnosed with MM (ICD-9-CM: 203.0X) between January 2008 and June 2013, who were free of MM claims 12 months prior to the first diagnosis and were continuously enrolled in the health plan for at least an additional 24 months following the initial diagnosis. We estimated total health care costs by including both payments made by insurers and patient out-of-pocket medical expenses.
Results: A total of 6,238 patients were included in the analysis, of whom 702 (11.3%) received stem cell transplant (SCT). The mean age was 63.1 years and 49.6% were males. Total health care expenses amounted to $65,607 per patient per year (over the first 2 years after diagnosis), which included inpatient and outpatient services as well as pharmacy costs. When the costs were analyzed by transplantation status, annual costs per patient were $182,061 for those receiving SCT compared with $50,840 for those who did not receive SCT. For patients who received SCT, outpatient services accounted for the highest percentage of total cost at 45.8%, followed by inpatient care (33.9%) and drug cost (20.3%). For patients who did not receive SCT, outpatient care remained the most expensive cost component at 54.0%, followed by inpatient care and drug cost (23.0%, respectively). Compared with the first year of treatment, total health care expenses over the second year were lower by 44.0% in patients who received SCT ($233,467 to $130,654) and by 27.1% in patients who did not receive SCT ($58,819 to $42,861).
Conclusion: The results from this analysis suggest that medical costs accounted for about three-fourths of the total health care costs over the first 2 years in newly diagnosed MM patients, with drug costs accounting for the remaining fourth. MM treatment expenses were considerably higher in the first year following diagnosis than in the subsequent year.

Disclosures
Hu: Celgene: Employment. Cai:Celgene Corp: Employment, Equity Ownership. Binder:Celgene Corp: Employment, Equity Ownership. Monzini:Celgene Corp: Employment, Equity Ownership. Nagarwala:Celgene Corp: Employment.