Multiple myeloma care, treatment patterns, and treatment durations in academic and community care settings

Field: Medicine (Health Sciences)

Evaluate multiple myeloma (MM) treatment patterns, healthcare utilization (HCRU), and costs from academic and community settings. This observational study linked US MM insurance claims (1 April 2017–30 June 2022) with provider affiliations to evaluate patient characteristics and treatment durations across patient cohorts defined by care setting of treatment (academic only, community only, mixed [both]), as well as treatment patterns, HCRU, and costs of care (e.g. treatment, office visits, hospitalization) in each setting. 3778 patients were included. By cohort (n = 530 academic; n = 1647 community), the community cohort was older with more comorbidities. Mixed-cohort patients (n = 1601) frequently initiated treatment at community centers and briefly shifted to academic centers for transplant. Among 3778 patients who received MM-related care, most claims were from the community setting. The academic setting had high rates of claims for proteasome inhibitors (56.3% of patients) and steroids (52.5%); the community setting had high rates for immunomodulatory drugs (75.1%) and steroids (85.0%). Stem cell transplant claims were more common for academic versus community (21.4%/7.3%). Treatment duration/time to next therapy were similar between cohorts. Costs were generally higher in the academic versus community settings. Improved patient support is needed in community settings, where most MM care occurs. Patients with a type of blood cancer called multiple myeloma (MM) face complex treatment journeys, and most patients require multiple treatments over time to control the disease. Patients can receive treatments in different care settings. An academic setting includes hospitals/healthcare centers that train doctors and medical students. A community setting includes non-academic hospitals and centers. To access different treatments, patients with MM often receive care in both settings. Research has shown that patients treated in academic settings tend to live longer than patients treated in community settings, but more research is needed to understand the reasons for this difference. The goal of this study was to determine if there were differences between patients who received MM treatments in academic versus community settings, examine the types of MM treatments given, the services received, and the costs in each setting. We found that patients received most of their MM care in the community setting. Patients who received all their MM treatments in a community setting were older, more likely to have multiple health complications, and less likely to participate in clinical trials. A specialized treatment called a stem cell transplant was more frequently given in the academic setting, and patients often moved between settings to receive this treatment. In both settings, patients were often treated with the same drug more than once, which could reduce its effectiveness. Costs overall were higher in the academic setting. These findings show a need for new treatments that are available in both academic and community settings.