Management of relapsed or refractory multiple myeloma in French hospitals and estimation of associated direct costs: a multi-centre retrospective cohort study
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. Objectiv...
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| Published in | Journal of clinical pharmacy and therapeutics Vol. 36; no. 1; pp. 19 - 26 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.02.2011
Blackwell John Wiley & Sons, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0269-4727 1365-2710 1365-2710 |
| DOI | 10.1111/j.1365-2710.2009.01153.x |
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| Abstract | 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. |
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| AbstractList | 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.
Our aim is to review the therapeutic management of such patients in France and to estimate the associated costs.
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.
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%).
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. 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. 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.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.Our aim is to review the therapeutic management of such patients in France and to estimate the associated costs.OBJECTIVEOur aim is to review the therapeutic management of such patients in France and to estimate the associated costs.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.METHODSA retrospective cohort study, based on chart reviews, was conducted in French Haematology Departments over the period 2004-2007 and the associated direct costs estimated.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%).RESULTSOne 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%).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.WHAT IS NEW AND CONCLUSIONThe 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. 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 23.53months. 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[Euro 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. 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 [euro] 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. |
| Author | Fermand, J. P. Fagnani, F. Moreau, P. Armoiry, X. Facon, T. Hulin, C. Benboubker, L. Aulagner, G. |
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| Keywords | 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 |
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| References | San Miguel JF, Schlag R, Khuageva NK et al. VISTA Trial Investigators (2008) Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. New England Journal of Medicine, 359, 906-917. Moeremans K, Annemans L (2006) An update: health economics of managing multiple myeloma. European Journal of Cancer, 42, 1684-1691. Epub 2006 June 16. Review. Smith A, Wisloff F, Samson D, UK Myeloma Forum; Nordic Myeloma Study Group (2006) Guidelines on the diagnosis and management of multiple myeloma 2005. British Journal Haematology, 132, 410-451. Weber DM, Chen C, Niesvizky R et al. (2007) Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. New England Journal of Medicine, 357, 2133-2142. Dimopoulos M, Spencer A, Attal M et al. (2007) Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. New England Journal of Medicine, 357, 2123-2132. Ghatnekar O, Alvegfi.rd T, Conradi N, Lenhoff S, Mellqvist H, Persson U, Löthgren N (2008) Direct hospital resource utilization and costs of treating patients with multiple myeloma in southwest Sweden: a 5-year retrospective analysis. Clinical Therapeutics, 30, 1704-1710. Attal M, Harousseau JL, Stoppa AM et al. (1996) A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myelome. New England Journal of Medicine, 335, 91-97. Kyle RA, Rajkumar SV (2004) Multiple myeloma. New England Journal of Medicine, 351, 1860-1873. Review. Erratum in: N Engl J Med 2005 March 17; 352 (11): 1163. Richardson PG, Sonneveld P, Schuster MW et al. (2005) Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. New England Journal of Medicine, 352, 2487-2498. Armoiry X, Aulagner G, Facon T (2008) Lenalidomide in the treatment of multiple myeloma: a review. Journal of Clinical Pharmacy and Therapeutics, 33, 219-226. Anderson KC, Hamblin TJ, Traynor A (1999) Management of multiple myeloma today. Seminars in Hematology, 36(1 Suppl. 3), 3-8. Review. Rajkumar SV, Kyle RA (2005) Multiple myeloma: diagnosis and treatment. Mayo Clinic Proceedings, 80, 1371-1382. Bang SM, Lee JH, Yoon SS et al. (2006) A multicenter retrospective analysis of adverse events in Korean patients using bortezomib for multiple myeloma. International Journal of Hematology, 83, 309-313. Facon T, Mary JY, Hulin C et al. Intergroupe Francophone du Myélome (2007) Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet, 370, 1209-1218. Pineda-Roman M, Zangari M, van Rhee F et al. (2008) VTD combination therapy with bortezomib-thalidomide-dexamethasone is highly effective in advanced and refractory multiple myeloma. Leukemia, 22, 1419-1427. Barlogie B, Shaughnessy J, Tricot G, Jacobson J, Zangari M, Anaissie E, Walker R, Crowley J (2004) Treatment of multiple myeloma. Blood, 103, 20-32. Orlowski RZ, Nagler A, Sonneveld P et al. (2007) Randomized phase III study of pegylated liposomal doxorubicin plus bortezomib compared with bortezomib alone in relapsed or refractory multiple myeloma: combination therapy improves time to progression. Journal of Clinical Oncology, 25, 3892-3901. Epub 2007 August 6. Barlogie B, Desikan R, Eddlemon P et al. (2001) Extended survival in advanced and refractory multiple myeloma after single-agent thalidomide: identification of prognostic factors in a phase 2 study of 169 patients. Blood, 98, 492-494. 2007; 357 2004; 351 2006; 42 2004; 103 2006; 83 2007; 370 2005; 352 1999; 36 1998 2006; 132 2008; 359 2005; 80 2008; 33 2008; 22 2008; 30 1996; 335 2007; 25 2001; 98 |
| References_xml | – reference: Richardson PG, Sonneveld P, Schuster MW et al. (2005) Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. New England Journal of Medicine, 352, 2487-2498. – reference: Barlogie B, Shaughnessy J, Tricot G, Jacobson J, Zangari M, Anaissie E, Walker R, Crowley J (2004) Treatment of multiple myeloma. Blood, 103, 20-32. – reference: San Miguel JF, Schlag R, Khuageva NK et al. VISTA Trial Investigators (2008) Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. New England Journal of Medicine, 359, 906-917. – reference: Anderson KC, Hamblin TJ, Traynor A (1999) Management of multiple myeloma today. Seminars in Hematology, 36(1 Suppl. 3), 3-8. Review. – reference: Attal M, Harousseau JL, Stoppa AM et al. (1996) A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myelome. New England Journal of Medicine, 335, 91-97. – reference: Smith A, Wisloff F, Samson D, UK Myeloma Forum; Nordic Myeloma Study Group (2006) Guidelines on the diagnosis and management of multiple myeloma 2005. British Journal Haematology, 132, 410-451. – reference: Bang SM, Lee JH, Yoon SS et al. (2006) A multicenter retrospective analysis of adverse events in Korean patients using bortezomib for multiple myeloma. International Journal of Hematology, 83, 309-313. – reference: Ghatnekar O, Alvegfi.rd T, Conradi N, Lenhoff S, Mellqvist H, Persson U, Löthgren N (2008) Direct hospital resource utilization and costs of treating patients with multiple myeloma in southwest Sweden: a 5-year retrospective analysis. Clinical Therapeutics, 30, 1704-1710. – reference: Dimopoulos M, Spencer A, Attal M et al. (2007) Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. New England Journal of Medicine, 357, 2123-2132. – reference: Facon T, Mary JY, Hulin C et al. Intergroupe Francophone du Myélome (2007) Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet, 370, 1209-1218. – reference: Armoiry X, Aulagner G, Facon T (2008) Lenalidomide in the treatment of multiple myeloma: a review. Journal of Clinical Pharmacy and Therapeutics, 33, 219-226. – reference: Barlogie B, Desikan R, Eddlemon P et al. (2001) Extended survival in advanced and refractory multiple myeloma after single-agent thalidomide: identification of prognostic factors in a phase 2 study of 169 patients. Blood, 98, 492-494. – reference: Rajkumar SV, Kyle RA (2005) Multiple myeloma: diagnosis and treatment. Mayo Clinic Proceedings, 80, 1371-1382. – reference: Moeremans K, Annemans L (2006) An update: health economics of managing multiple myeloma. European Journal of Cancer, 42, 1684-1691. Epub 2006 June 16. Review. – reference: Pineda-Roman M, Zangari M, van Rhee F et al. (2008) VTD combination therapy with bortezomib-thalidomide-dexamethasone is highly effective in advanced and refractory multiple myeloma. Leukemia, 22, 1419-1427. – reference: Weber DM, Chen C, Niesvizky R et al. (2007) Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. New England Journal of Medicine, 357, 2133-2142. – reference: Orlowski RZ, Nagler A, Sonneveld P et al. (2007) Randomized phase III study of pegylated liposomal doxorubicin plus bortezomib compared with bortezomib alone in relapsed or refractory multiple myeloma: combination therapy improves time to progression. Journal of Clinical Oncology, 25, 3892-3901. Epub 2007 August 6. – reference: Kyle RA, Rajkumar SV (2004) Multiple myeloma. New England Journal of Medicine, 351, 1860-1873. Review. Erratum in: N Engl J Med 2005 March 17; 352 (11): 1163. – volume: 83 start-page: 309 year: 2006 end-page: 313 article-title: A multicenter retrospective analysis of adverse events in Korean patients using bortezomib for multiple myeloma publication-title: International Journal of Hematology – volume: 370 start-page: 1209 year: 2007 end-page: 1218 article-title: Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced‐intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99‐06): a randomised trial publication-title: Lancet – volume: 30 start-page: 1704 year: 2008 end-page: 1710 article-title: Direct hospital resource utilization and costs of treating patients with multiple myeloma in southwest Sweden: a 5‐year retrospective analysis publication-title: Clinical Therapeutics – volume: 359 start-page: 906 year: 2008 end-page: 917 article-title: Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma publication-title: New England Journal of Medicine – volume: 357 start-page: 2123 year: 2007 end-page: 2132 article-title: Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma publication-title: New England Journal of Medicine – volume: 103 start-page: 20 year: 2004 end-page: 32 article-title: Treatment of multiple myeloma publication-title: Blood – volume: 25 start-page: 3892 year: 2007 end-page: 3901 article-title: Randomized phase III study of pegylated liposomal doxorubicin plus bortezomib compared with bortezomib alone in relapsed or refractory multiple myeloma: combination therapy improves time to progression publication-title: Journal of Clinical Oncology – volume: 36 start-page: 3 issue: 1 Suppl. 3 year: 1999 end-page: 8 article-title: Management of multiple myeloma today publication-title: Seminars in Hematology – volume: 335 start-page: 91 year: 1996 end-page: 97 article-title: A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myelome publication-title: New England Journal of Medicine – volume: 352 start-page: 2487 year: 2005 end-page: 2498 article-title: Bortezomib or high‐dose dexamethasone for relapsed multiple myeloma publication-title: New England Journal of Medicine – volume: 98 start-page: 492 year: 2001 end-page: 494 article-title: Extended survival in advanced and refractory multiple myeloma after single‐agent thalidomide: identification of prognostic factors in a phase 2 study of 169 patients publication-title: Blood – volume: 33 start-page: 219 year: 2008 end-page: 226 article-title: Lenalidomide in the treatment of multiple myeloma: a review publication-title: Journal of Clinical Pharmacy and Therapeutics – volume: 357 start-page: 2133 year: 2007 end-page: 2142 article-title: Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America publication-title: New England Journal of Medicine – volume: 42 start-page: 1684 year: 2006 end-page: 1691 article-title: An update: health economics of managing multiple myeloma publication-title: European Journal of Cancer – volume: 80 start-page: 1371 year: 2005 end-page: 1382 article-title: Multiple myeloma: diagnosis and treatment publication-title: Mayo Clinic Proceedings – volume: 351 start-page: 1860 year: 2004 end-page: 1873 article-title: Multiple myeloma publication-title: New England Journal of Medicine – year: 1998 – volume: 132 start-page: 410 year: 2006 end-page: 451 article-title: Guidelines on the diagnosis and management of multiple myeloma 2005 publication-title: British Journal Haematology – volume: 22 start-page: 1419 year: 2008 end-page: 1427 article-title: VTD combination therapy with bortezomib‐thalidomide‐dexamethasone is highly effective in advanced and refractory multiple myeloma publication-title: Leukemia |
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What is known and background: For relapsed or refractory multiple myeloma (RRMM), a series of novel agents (thalidomide, bortezomib and lenalidomide)... For relapsed or refractory multiple myeloma (RRMM), a series of novel agents (thalidomide, bortezomib and lenalidomide) has emerged during the latest decade,... Summary What is known and background: For relapsed or refractory multiple myeloma (RRMM), a series of novel agents (thalidomide, bortezomib and lenalidomide)... What is known and background: For relapsed or refractory multiple myeloma (RRMM), a series of novel agents (thalidomide, bortezomib and lenalidomide) has... |
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| SubjectTerms | 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 |
| Title | Management of relapsed or refractory multiple myeloma in French hospitals and estimation of associated direct costs: a multi-centre retrospective cohort study |
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