Multiple myeloma is the second most common hematological cancer. Although it accounts for only a relatively small percentage of all cancer types, the costs associated with managing multiple myeloma are considerable. Available studies are mainly focused on health care costs. The Costo del Mieloma Multiplo (Cost of MM, CoMiM) study investigated the cost of illness of multiple myeloma in Italy during one year of disease management.
Methods
CoMiM is a retrospective, prevalence-based, multi-center, cross-sectional study based on a stratified sample of patients seen during normal clinical practice (asymptomatic; symptomatic on drugs; symptomatic receiving autologous stem cell transplantation; plateau/remission). Demographics, clinical history, health care and non-health care resource consumption data were collected. Costs were evaluated from the societal viewpoint and expressed in Euro 2008.
Results
Data on 236 patients were analyzed (39 asymptomatic, 17%; 29 symptomatic receiving autologous stem-cell transplantation, 12%; 105 symptomatic receiving drugs, 44%; 63 plateau/remission, 27%). The total cost of illness reached € 19,267.1 ± 25,078.6 (asymptomatic, € 959.3 ± 1091.6; symptomatic receiving drugs, € 21,707.8 ± 21,785.3; symptomatic receiving autologous stem-cell transplantation, € 59,243.7 ± 24,214.0; plateau/remission, € 8130.7 ± 15,092.5). The main cost drivers of total cost of illness were drugs and hospital admissions (46.1% and 29.4%, respectively). Antineoplastics and immunomodulators drove the cost of drugs (21.6% and 21.1% of the total cost of illness). Cost of antineoplastics was led by bortezomib (97.4%), whereas the cost driver for immunomodulators was lenalidomide (99.4%). Cost of hospitalization funded by the Italian National Health Service was strongly influenced by transplantation (94.6%), whereas chemotherapy and skeletal fractures did not exceed 1% and 2%, respectively.
Conclusions
Despite some limitations, the CoMiM study provides Italian health care decision-makers with an insight into the stratified cost of illness of multiple myeloma patients.
Canadian Cancer Society/National Cancer Institute of Canada.Canadian cancer statistics 2007.Toronto: Canadian Cancer Society/National Cancer Institute of Canada, 2007.
2.
JemalA., SiegelR., WardE., HaoY., XuJ., MurrayT., ThunM.J.: Cancer statistics, 2008.CA Cancer J Clin, 58: 71–96, 2008.
3.
PiazzaF.A., GurrieriC., TrentinL., SemenzatoG.: Towards a new age in the treatment of multiple myeloma.Ann Hematol, 86: 159–172, 2007.
4.
SuppiahR., SrkalovicJ.G., HusseinM.A.: Immunomodulatory analogues of thalidomide in the treatment of multiple myeloma.Clin Lymphoma Myeloma, 6: 301–305, 2006.
FerlayJ., ShinH.R., BrayF., FormanD., MathersC., ParkinD.M.: GLOBOCAN 2008, Cancer incidence and mortality worldwide: IARC CancerBase No. 10.Lyon, France: International Agency for Research on Cancer, 2010. http://globocan.iarc.fr (Accessed December 30, 2010).
7.
KumarS.K., RajkumarS.V., DispenzieriA., LacyM.Q., HaymanS.R., BuadiF.K., ZeldenrustS.R., DingliD., RussellS.J., LustJ.A., GreippP.R., KyleR.A., GertzM.A.: Improved survival in multiple myeloma and the impact of novel therapies.Blood, 111: 2516–2520, 2008.
8.
SmithA., WisløffF., SamsonD.: Guidelines on the diagnosis and management of multiple myeloma.Br J Haematol, 132: 410–451, 2005.
9.
FaconT., MaryJ.Y., HulinC., BenboubkerL., AttalM., PegourieB., RenaudM., HarousseauJ.L., GuillermG., ChaleteixC., DibM., VoillatL., MaisonneuveH., TroncyJ., DorvauxV., MonconduitM., MartinC., CasassusP., JaubertJ., JardelH., DoyenC., KolbB., AnglaretB., GrosboisB., Yakoub-AghaI., MathiotC., Avet-LoiseauH; Intergroupe Francophone du Myélome: 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, 2007.
10.
RichardsonP.G., SonneveldP., SchusterM., IrwinD., StadtmauerE., FaconT., HarousseauJ.L., Ben-YehudaD., LonialS., GoldschmidtH., ReeceD., MiguelJ.S., BladéJ., BoccadoroM., CavenaghJ., AlsinaM., RajkumarS.V., LacyM., JakubowiakA., DaltonW., BoralA., EsseltineD.L., SchenkeinD., AndersonK.C.: Extended follow-up of a phase 3 trial in relapsed multiple myeloma: final time-to-event results of the APEX trial.Blood, 110: 3557–3560, 2007.
11.
WeberD.M., ChenC., NiesvizkyR., WangM., BelchA., StadtmauerE.A., SiegelD., BorrelloI., RajkumarS.V., Chanan-KhanA.A., LonialS., YuZ., PatinJ., OlesnyckyjM., ZeldisJ.B., KnightRD; Multiple Myeloma (009) Study Investigators: Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America.N Engl J Med, 357: 2133–2142, 2007.
12.
PalumboA., BringhenS., LiberatiA.M., CaravitaT., FalconeA., CalleaV., MontanaroM., RiaR., CapaldiA., ZambelloR., BenevoloG., DerudasD., DoreF., CavalloF., GayF., FalcoP., CicconeG., MustoP., CavoM., BoccadoroM.: Oral melphalan, prednisone, and thalidomide in elderly patients with multiple myeloma: updated results of a randomized controlled trial.Blood, 112: 3107–3114, 2008.
13.
DimopoulosM., SpencerA., AttalM., PrinceH.M., HarousseauJ.L., DmoszynskaA., San MiguelJ., HellmannA., FaconT., FoàR., CorsoA., MasliakZ., OlesnyckyjM., YuZ., PatinJ., ZeldisJ.B., KnightRD; Multiple Myeloma (010) Study Investigators: Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma.N Engl J Med, 357: 2123–2132, 2007.
14.
StadtmauerE.A., WeberD.M., NiesvizkyR., BelchA., PrinceM.H., San MiguelJ.F., FaconT., OlesnyckyjM., YuZ., ZeldisJ.B., KnightR.D., DimopoulosM.A.: Lenalidomide in combination with dexamethasone at first relapse in comparison with its use as later salvage therapy in relapsed or refractory multiple myeloma.Eur J Haematol, 82: 426–432, 2009.
15.
GrootM.T., HuijgensP.C., WijermansP., and Uylde GrootC.A.: Costs of multiple myeloma and associated skeletal-related events in The Netherlands.Expert Rev Pharmacoeconomics Outcomes Res, 4: 565–572, 2004.
16.
WisløffF., EikaS., HippeE., HjorthM., HolmbergE., KaasaS., PalvaI., WestinJ.: Measurement of health-related quality of life in multiple myeloma.Br J Haematol.92: 604–613. 1996.
17.
WisløffF., HjorthM., KaasaS., WestinJ.for the Nordic Myeloma Study Group: Effect of interferon on the health-related quality of life of multiple myeloma patients: results of a Nordic randomized trial comparing melphalan–prednisone to melphalan–prednisone + alpha-interferon.Br J Haematol, 94: 324–332, 1996.
18.
WisløffF., HjorthM.for the Nordic Myeloma Study Group: Health-related quality of life assessed before and during chemotherapy predicts for survival in multiple myeloma.Br J Haematol, 97: 29–37, 1997.
19.
GhatnekarO., AlvegårdT., ConradiN., LenhoffS., MellqvistU.H., PerssonU., LöthgrenM.: Direct hospital resource utilization and costs of treating patients with multiple myeloma in southwest Sweden: a 5-year retrospective analysis.Clin Ther, 30: 1704–1713, 2008.
20.
MoeremansK., AnnemansL.: An update: health economics of managing multiple myeloma.Eur J Cancer, 42: 1684–1691, 2006.
21.
KolevaD., CortelazzoS., ToldoC., GarattiniL.: Healthcare costs of multiple myeloma: an Italian study.Eur J Cancer Care, 20: 330–336, 2011.
22.
HodgsonT.A., MeinersM.R.: Cost-of illness methodology: a guide to current practices and procedures.Millbank Memorial Fund Quarterly/Health and Society, 60: 429–462, 1982.
23.
DrummondM.F., SchulperM.J., TorranceG.W., O'BrienB.J., StoddartG.L.: Methods for the economic evaluation of health care programmes, 3rd edn., Oxford University Press, Oxford, 2005.
24.
ArmitageP., BerryG., MatthewsJ.N.S.: Statistical methods in medical research, 4th edn., Blackwell Publishing, Malden, MA, 2002.
25.
Ministero della Salute: Progetto Mattoni SSN. Pronto Soccorso e sistema 118. Proposta metodologica per la valutazione dei costi dell'emergenza. Ministero della Salute, Rome, 23 January 2007.
26.
Ministero della Sanità: Decreto ministeriale n. 150 del 22 Luglio 1996. Prestazioni di assistenza specialistica ambulatoriale erogabili nell'ambito del Servizio sanitario nazionale e relative tariffe. Supplemento ordinario alla Gazzetta Ufficiale n. 216 del 14 Settembre 1996, Serie generale. Istituto Poligrafico e Zecca dello Stato, Rome, 1996.
27.
Presidente della Repubblica: Decreto del Presidente della Repubblica 28 luglio 2000, n. 270. Regolamento di esecuzione dell'accordo collettivo nazionale per la disciplina dei rapporti con i medici di medicina generale. Supplemento ordinario N. 165/L alla Gazzetta Ufficiale n. 230 del 2 Ottobre 2000, Serie Generale. Istituto Poligrafico e Zecca dello Stato, Rome, 2000.
28.
Conferenza Permanente per i Rapporti tra lo Stato le Regioni e le Province Autonome di Trento e Bolzano: Tariffa Unica Convenzionale per le prestazioni di assistenza ospedaliera. Regole e tariffe valide per l'anno 2008. Conferenza Permanente per i Rapporti tra lo Stato le Regioni e le Province Autonome di Trento e Bolzano. Conferenza Permanente per i Rapporti tra lo Stato le Regioni e le Province Autonome di Trento e Bolzano, Rome, 29 July 2009.
29.
BrouwerW., RuttenF., and KoopmanschapM.: Costing in economic evaluations. In: Economic Evaluation in Health Care: Merging Theory with Practice, DrummondM., McGuireA., eds, pp 68–93, Oxford University Press, Oxford, 2001.
30.
Farmadati: Banca dati Compendio Farmaceutico Telematico2008. http://www.farmadati.it (Accessed November 9, 2010).
PosnetJ., IanS.: Indirect cost in economic evaluation: the opportunity cost of unpaid inputs.Health Econ, 5: 13–23, 1996.
33.
Federproprietà: Uppi, Confappi, Fesica Confsal, Confsal Fisals. Contratto collettivo nazionale di lavoro colf e badanti. Rome, 12 June 2008.
34.
Agenzia delle Entrate: Annuario del contribuente 2009.Agenzia delle Entrate, Rome, 27 May 2009.
35.
Banca d'Italia: I bilanci delle famiglie italiane nell'anno 2008. Supplementi al Bollettino Statistico. Nuova serie. Anno XX – Numero 8. Banca d'Italia, Rome, 10 February 2010.
Sistema Statistico Nazionale - Istituto Nazionale di Statistica: Compendio Statistico Italiano.www.istat.it/Anumital/Astatset/prez.htm (Accessed 10 November 2010).
DavidsonR., MacKinnonJ.G.: Econometric Theory and Methods.Oxford University Press, Oxford, 2004.
42.
KobeltG., BergJ., LindgrenP., BattagliaM., LucioniC., UccelliA.: Costs and quality of life of multiple sclerosis in Italy.Eur J Health Econ, 7 Suppl 2: S45–S54, 2006.
43.
AltekruseS.F., KosaryC.L., KrapchoM., NeymanN., AminouR., WaldronW., RuhlJ., HowladerN., TatalovichZ., ChoH., MariottoA., EisnerM.P., LewisD.R., CroninK., ChenH.S., FeuerE.J., StinchcombD.G., EdwardsB.K., eds. SEER Cancer Statistics Review, 1975–2007, National Cancer Institute. Bethesda, MD.http://seer.cancer.gov/csr/1975_2007/,sect_18_table.07, based on November 2009 SEER data submission, posted to the SEER web site, 2010(Accessed November 10, 2010).
44.
CarusoE., DirindinN.: La sanità nel 2008: relazioni pericolose. In: GuerraM.C., ZanardiA., eds. La finanza pubblica italiana. Rapporto 2009. il Mulino, Bologna, 2009: 81–104.
