Blood cancers

Bortezomib does not increase treatment costs in myeloma

The use of the proteasome inhibitor bortezomib does not increase overall treatment costs in myeloma compared to previous conventional therapies, a South Australian study has found.

An analysis of real-world treatment costs for 70 patients treated with bortezomib in Adelaide since 2012 found that overall expenditure on hospitalisation was no greater than costs for a historical  cohort of patients with myeloma who were treated before 2012 with traditional therapies such as thalidomide.

Led by Dr Jane Thompson of the Haematology Department, Royal Adelaide Hospital, the study compared costs of treatment including hospital admissions, outpatient visits, investigations, supportive therapies and other drugs, excluding the costs of the novel therapy in the first 12 months of treatment for myeloma patients treated upfront with subcutaneous bortezomib

After adjusting for inflation and other variables such as patient age and co-morbidities, the average yearly cost of care was $24,872 for bortezomib-treated patients and $25,546 for the historical control group (2.6% lower, odds ration 0.974)

Patients in the control cohort were treated with melphalan and prednisolone and/or thalidomide upfront.

The ISS stage at baseline had a significant impact on costs of treatment, which were 62% higher  for patients at Stage 3  as compared with Stage 1. Similarly costs were 51.5% higher for single autologous transplant patients compared to non-transplant patients. Treatment costs were 36% lower for trial eligible compared to non-trial patients.

No specific interventions were found to be significant different driver of costs.

However,  the bortezomib-treated group tended to have lower hospital admission costs and overall outpatient costs compared to the traditional treatment group.

The lower costs seen for bortezomib treated patients were due to less expensive visits  and lengths of appointments despite the overall number of visits being higher.

“These findings possibly reflect increased surveillance associated with a newly introduced treatment,” the study authors noted.

The study authors said their findings derived from real-world use rather than pharmaceutical industry sponsored trials showed that costs were similar for bortezomib regimens as compared with traditional regimens in the first-line treatment of myeloma.

“Our data provide reassurance that funding justification for the use of this novel agent need not be influenced by the argument that newer agents may incur additional real-world costs,” they concluded.

The study is published in the British Journal of Haematology and had no industry funding.

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