PS4-1
COSTS OF FIRST-LINE TREATMENT FOR ELDERLY MULTIPLE MYELOMA PATIENTS WHO ARE NOT TRANSPLANT CANDIDATES IN THE SERBIAN HEALTH CARE SYSTEM
Tuesday, June 14, 2016
Exhibition Space (30 Euston Square)
Durda Vukicevic, MD, UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, Hall in Tyrol, Austria, Ursula Rochau, MD, MSc, UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and HTA, Department of Public Health and HTA/ ONCOTYROL - Center for Personalized Cancer Medicine, Area 4 HTA and Bioinformatics, Hall in Tyrol/ Innsbruck, Austria, Aleksandar Savic, MD, PhD, Clinic for hematology, Clinical Center of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia, Monika Buchberger, MSc, UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, Hall i.T., Austria, Milica Jevdjevic, DMD, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria, Gaby Sroczynski, MPH, Dr.PH, UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and HTA, Department of Public Health, Health Services Research and HTA/ ONCOTYROL - Area 4, HTA and Bioinformatics, Hall i.T./Innsbruck, Austria and Uwe Siebert, MD, MPH, MSc, ScD, UMIT, Hall in Tirol (Austria) / Boston (USA), Austria
Purpose: We analyzed the treatment patterns, health care utilization and costs of first-line treatments for elderly multiple myeloma patients who are not transplant candidates in Serbia. Multiple myeloma (MM) is an incurable plasma-cell neoplasm accounting for approximately 10% of all hematologic malignancies worldwide. The economic burden of the disease includes the costs of diagnostic procedures, treatment, management of adverse events and outpatient care. The impact of MM on resource use and costs has not been previously explored outside of the contexts of USA and Western Europe.
Method(s): We performed a micro-costing study from a Serbian national health system perspective including costs of diagnostic procedures, treatment, hospitalization, outpatient care, drug administration and adverse events. We followed recommendations of the Serbian guideline for cost-effectiveness analysis. The current MM treatment and diagnostic protocols were derived from the guideline for diagnosis and treatment of MM in Serbia, revised and adapted by Serbian clinicians. For the unit costs of diagnostic procedures, medications and hospital days, we used the tariff book of the republic health insurance. Details on treatment patterns and menagement of the disease were discussed with Serbian clinicians. All costs were priced in 2016 and converted to euro (€) according to the exchange rate on February 29, 2016 (1€=123.5 Serbian dinars).
Result(s): Total costs of the four currently used protocols were analyzed and the results were as follows: 30,730€ for melphalan, prednisone (MP) and bortezomib, 22,370€ for cyclophosphamide, dexamethasone (CD) and bortezomib, 1,730€ for MP and thalidomide and 1,850€ for CD and thalidomide. Bendamustine-prednisone protocol is also used in the Serbian setting and refunded by the republic health insurance fund for first line treatment of MM patients with polyneuropathy, but the price of bendamustine in Serbia was not available. The cost of diagnostic procedures and hospitalization were 890€ and 120€ per patient respectively. The most costly element of multiple myeloma management in Serbia is the treatment of the disease, which accounts for more than 90% of the total costs of the disease management. In comparison to the other studies evaluating costs of multiple myeloma, the impact of the drug acquisition costs is higher in the Serbian context.
Conclusion(s): The costs of MM treatment in the Serbian context are mainly driven by anti-myeloma drug costs. Costs for diagnostic procedures, hospitalization and outpatient care are relatively moderate.
