Disparities in Healthcare Resource Utilization for Multiple Myeloma
Authors: Fiala Mark A. , Wildes Tanya M. , Schroeder Mark A. , Ghobadi Armin , Stockerl-Goldstein Keith E. , Vij Ravi 
Published: October 2019

Abstract

Background: Nearly half of older African-Americans who develop multiple myeloma (MM) do not receive systemic treatment. Those who do are less likely to receive newer treatments, such as novel agents and stem cell transplant, than their peers. In this study, we sought to determine if disparities in resource utilization exist even among patients receiving similar treatment.
Methods: All newly diagnosed MM cases from 2007-2013 in the SEER-Medicare dataset were reviewed along with their corresponding claims data through 2014. We excluded cases 1) not enrolled in Medicare Part A, B, and D; 2) HMO enrollees; 3) those diagnosed prior to age 65; 4) all patients who did not receive a proteasome inhibitor and/or an immunomodulatory drug within 6 months; 5) those who underwent stem cell mobilization or transplantation; or 6) died within 12 months of MM diagnosis. All reported medical costs including both those paid by Medicare and patient copays for the first 12 months post-diagnosis were captured and adjusted for inflation.
Results: 2,841 patients were included. The median age was 74 at diagnosis (range 65-96) and 51% were male. 79% (n = 2,247) were white, 14% (n = 403) African-American/Black, and 7% (n = 191) were another race. Overall, the median expenditure was $127,054 in the 12 months post-diagnosis; $121,400 for African-Americans, $127,810 for whites, and $119,209 for other races.
After controlling for age, gender, comorbidities, a proxy measure of performance status, and MM related renal impairment and bone disease, African-American patients had $10,524 less in overall expenditures on average than white patients. This can partly be attributed to lower expenditures on MM drugs. On average African-American patients had $5,520 less in MM drug expenditures (p = 0.0062). African-Americans also had 9.3 less days of interaction with outpatient services compared to their white peers (p < 0.0001), but 4.6 more days in inpatient settings (p = 0.0208).
There was no statistically significant difference between white patients and patients of races other than white or African-American in overall expenditure or MM drug expenditure but members of other races had 8.2 less days of interaction with outpatient services (p = 0.0004) and 5.7 less days in inpatient settings (p = 0.0350).
The estimated median overall survival for African-American patients was 44 months (95% CI 40-51) compared to 47 (45-50) for white patients and 57 (44-66) for patients of other races (p = 0.097). Race was not associated with overall survival in multivariate analysis.
Conclusion: Minority patients with MM received fewer services during the 12 months post-diagnosis. It is currently unclear if this is due to inferior care, overuse among white patients, or related to the clinical needs of the patients.

Disclosures
Schroeder: Amgen Inc.: Consultancy, Membership on an entity's Board of Directors or advisory committees. Vij:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Jansson: Honoraria, Membership on an entity's Board of Directors or advisory committees; Karyopharma: Honoraria, Membership on an entity's Board of Directors or advisory committees.