Management of relapsed or refractory multiple myeloma in French hospitals and estimation of associated direct costs: a multi-centre retrospective cohort study

• Published in: Journal of clinical pharmacy and therapeutics Vol. 36; no. 1; pp. 19 - 26
• Main Authors: Armoiry, X., Fagnani, F., Benboubker, L., Facon, T., Fermand, J. P., Hulin, C., Moreau, P., Aulagner, G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2011; Blackwell; John Wiley & Sons, Inc
• Subjects: Aged; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - economics; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Boronic Acids - administration & dosage; Boronic Acids - economics; Boronic Acids - therapeutic use; Bortezomib; cohort; Cohort Studies; Drug Costs - statistics & numerical data; Drug Resistance, Neoplasm; Drug Utilization - statistics & numerical data; Female; France; Health Care Costs - statistics & numerical data; Hematologic and hematopoietic diseases; Hospitals, University; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulinopathies; Immunopathology; lenalidomide; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical Records; Medical sciences; Middle Aged; Multiple Myeloma - drug therapy; Multiple Myeloma - economics; novel agents; Pharmacology. Drug treatments; Practice Patterns, Physicians' - statistics & numerical data; Pyrazines - administration & dosage; Pyrazines - economics; Pyrazines - therapeutic use; Recurrence; relapse or refractory multiple myeloma; retrospective analysis; Retrospective Studies; thalidomide; Thalidomide - administration & dosage; Thalidomide - analogs & derivatives; Thalidomide - economics; Thalidomide - therapeutic use; France; Europe; Antineoplastic agent; Relapse; Psychotropic; cohort; Myeloma; novel agents; Immunoglobulinopathy; Lymphoproliferative syndrome; Cohort study; Hospital; Sedative; Antiangiogenic agent; Thalidomide; Public health; Human; Immunopathology; Treatment resistance; Antileprous agent; Bortezomib; Lenalidomide; Hypnotic; Malignant hemopathy; Anti-Tumor Necrosis Factor-alpha; Retrospective; relapse or refractory multiple myeloma; Immunomodulator; retrospective analysis; Clinical management; Follow up study; Analog; Proteasome inhibitor; Dipeptides; Antibacterial agent; Cancer
• ISSN: 0269-4727; 1365-2710; 1365-2710
• DOI: 10.1111/j.1365-2710.2009.01153.x

Summary What is known and background:  For relapsed or refractory multiple myeloma (RRMM), a series of novel agents (thalidomide, bortezomib and lenalidomide) has emerged during the latest decade, but their use in routine clinical practice is not well documented as well as the cost of RRMM. Objective:  Our aim is to review the therapeutic management of such patients in France and to estimate the associated costs. Methods:  A retrospective cohort study, based on chart reviews, was conducted in French Haematology Departments over the period 2004–2007 and the associated direct costs estimated. Results:  One hundred and two patients with a relapse after first‐line therapy were selected from five centres. The average follow‐up from diagnosis or the date of first relapse to death or to the latest news was respectively 56·25 and 23·53 months. Novel agents were used in 73% of all cases, and in all cases of first relapse. Thalidomide and bortezomib were respectively the most frequently used second‐line (57%) and third‐line treatments (44%). The average number of lines of treatment received per patient as from first relapse was 2·75 (min 1; max 8) and the mean direct cost per month was estimated at 3130 € after the first relapse. This cost was represented in greater part by the cost of chemotherapy drugs (66%). What is new and conclusion:  The use of novel agents such as thalidomide, bortezomib and lenalidomide for RRMM is highly prevalent in France from the first relapse. The associated medical cost is substantial mainly due to the cost of the new agents.