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Erschienen in: Current Hematologic Malignancy Reports 6/2022

30.08.2022 | Health Economics (N Khera, Section Editor)

Value in Myeloma Care: Myth or Reality

verfasst von: Evguenia Ouchveridze, Katherine Berger, Ghulam Rehman Mohyuddin

Erschienen in: Current Hematologic Malignancy Reports | Ausgabe 6/2022

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Abstract

Purpose of Review

Despite tremendous advances in multiple myeloma (MM) care, the disease maintains considerable morbidity and requires long-term treatment associated with significant financial toxicity to patients and high costs to society. In this review, we explore why — despite treatment advances — value in MM treatment is largely a myth, then explain some ways the myth might become a reality.

Recent Findings

We discuss how value-based care in MM should include patient-centered outcomes such as financial toxicity and quality of life, which are heavily impacted by cost of drugs and the indefinite duration of therapy that is standard in MM treatment. We propose multiple paths to work toward reducing cost and augmenting value of care for patients with MM, including improving access to generic drugs, increasing federal funding for clinical trials, designing more patient-centric clinical trials, and exploring the utilization of minimal residual disease (MRD)-driven treatment de-escalation, among others.

Summary

We remain optimistic that despite the challenges, we can work toward making progress in the realm of value-based care for patients with MM and make it a reality.
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Literatur
1.
Zurück zum Zitat Joseph NS, Kaufman JL, Dhodapkar MV, Hofmeister CC, Almaula DK, Heffner LT, et al. Long-term follow-up results of lenalidomide, bortezomib, and dexamethasone induction therapy and risk-adapted maintenance approach in newly diagnosed multiple myeloma. J Clin Oncol. 2020;38(17):1928–37.CrossRefPubMedPubMedCentral Joseph NS, Kaufman JL, Dhodapkar MV, Hofmeister CC, Almaula DK, Heffner LT, et al. Long-term follow-up results of lenalidomide, bortezomib, and dexamethasone induction therapy and risk-adapted maintenance approach in newly diagnosed multiple myeloma. J Clin Oncol. 2020;38(17):1928–37.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Ouchveridze E, Banerjee R, Desai A, Aziz M, Lee-Smith W, Mian H, et al. Financial toxicity in hematological malignancies: a systematic review. Blood Cancer J. 2022;12(4):74.CrossRefPubMedPubMedCentral Ouchveridze E, Banerjee R, Desai A, Aziz M, Lee-Smith W, Mian H, et al. Financial toxicity in hematological malignancies: a systematic review. Blood Cancer J. 2022;12(4):74.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Thorsteinsdottir S, Dickman PW, Landgren O, Blimark C, Hultcrantz M, Turesson I, et al. Dramatically improved survival in multiple myeloma patients in the recent decade: results from a Swedish population-based study. Haematologica. 2018;103(9):e412–e5.CrossRefPubMedPubMedCentral Thorsteinsdottir S, Dickman PW, Landgren O, Blimark C, Hultcrantz M, Turesson I, et al. Dramatically improved survival in multiple myeloma patients in the recent decade: results from a Swedish population-based study. Haematologica. 2018;103(9):e412–e5.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Brenner H, Gondos A, Pulte D. Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood. 2008;111(5):2521–6.CrossRefPubMed Brenner H, Gondos A, Pulte D. Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood. 2008;111(5):2521–6.CrossRefPubMed
6.
Zurück zum Zitat Bhattacharya K, Bentley JP, Ramachandran S, Chang Y, Banahan BF 3rd, Shah R, et al. Phase-specific and lifetime costs of multiple myeloma among older adults in the US. JAMA Netw Open. 2021;4(7):e2116357.CrossRefPubMedPubMedCentral Bhattacharya K, Bentley JP, Ramachandran S, Chang Y, Banahan BF 3rd, Shah R, et al. Phase-specific and lifetime costs of multiple myeloma among older adults in the US. JAMA Netw Open. 2021;4(7):e2116357.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Vincent RS. The high cost of prescription drugs: causes and solutions. Blood Cancer J. 2020;10(6):71.CrossRef Vincent RS. The high cost of prescription drugs: causes and solutions. Blood Cancer J. 2020;10(6):71.CrossRef
10.
Zurück zum Zitat Rajkumar SV. Value and cost of myeloma therapy. Am Soc Clin Oncol Educ Book. 2018;38:662–6.CrossRefPubMed Rajkumar SV. Value and cost of myeloma therapy. Am Soc Clin Oncol Educ Book. 2018;38:662–6.CrossRefPubMed
12.
Zurück zum Zitat Dusetzina SB. Your money or your life — the high cost of cancer drugs under Medicare Part D. New England JMed 2022. Dusetzina SB. Your money or your life — the high cost of cancer drugs under Medicare Part D. New England JMed 2022.
13.
Zurück zum Zitat Wouters OJ, McKee M, Luyten J. Estimated research and development investment needed to bring a new medicine to market, 2009-2018. JAMA. 2020;323(9):844–53.CrossRefPubMedPubMedCentral Wouters OJ, McKee M, Luyten J. Estimated research and development investment needed to bring a new medicine to market, 2009-2018. JAMA. 2020;323(9):844–53.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Prasad V, Mailankody S. Research and development spending to bring a single cancer drug to market and revenues after approval. JAMA Intern Med. 2017;177(11):1569–75.CrossRefPubMedPubMedCentral Prasad V, Mailankody S. Research and development spending to bring a single cancer drug to market and revenues after approval. JAMA Intern Med. 2017;177(11):1569–75.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Gyawali B, Hey SP, Kesselheim AS. Evaluating the evidence behind the surrogate measures included in the FDA’s table of surrogate endpoints as supporting approval of cancer drugs. E Clin Med. 2020;21:100332. Gyawali B, Hey SP, Kesselheim AS. Evaluating the evidence behind the surrogate measures included in the FDA’s table of surrogate endpoints as supporting approval of cancer drugs. E Clin Med. 2020;21:100332.
18.
Zurück zum Zitat Mohyuddin GR, Koehn K, Abdallah AO, Sborov W, Rajkumar D, Kumar SV, Mc Clune B, et al. Use of endpoints in multiple myeloma randomized controlled trials over the last 15 years: a systematic review. Am J Hematol. 2021;96(6):690–7.CrossRefPubMed Mohyuddin GR, Koehn K, Abdallah AO, Sborov W, Rajkumar D, Kumar SV, Mc Clune B, et al. Use of endpoints in multiple myeloma randomized controlled trials over the last 15 years: a systematic review. Am J Hematol. 2021;96(6):690–7.CrossRefPubMed
19.
Zurück zum Zitat Chakraborty R, Cannella L, Cottone F, Efficace F. Quality of patient-reported outcome reporting in randomised controlled trials of haematological malignancies according to international quality standards: a systematic review. Lancet Haematol. 2020;7(12):e892–901.CrossRefPubMed Chakraborty R, Cannella L, Cottone F, Efficace F. Quality of patient-reported outcome reporting in randomised controlled trials of haematological malignancies according to international quality standards: a systematic review. Lancet Haematol. 2020;7(12):e892–901.CrossRefPubMed
20.
Zurück zum Zitat Anderson KC, Auclair D, Adam SJ, Agarwal A, Anderson M, Avet-Loiseau H, et al. Minimal residual disease in myeloma: application for clinical care and new drug registration. Clin Cancer Res. 2021. Anderson KC, Auclair D, Adam SJ, Agarwal A, Anderson M, Avet-Loiseau H, et al. Minimal residual disease in myeloma: application for clinical care and new drug registration. Clin Cancer Res. 2021.
21.
Zurück zum Zitat Delforge M, Shah N, Miguel JSF, Braverman J, Dhanda DS, Shi L, et al. Health-related quality of life with idecabtagene vicleucel in relapsed and refractory multiple myeloma. Blood Adv. 2022;6(4):1309–18.CrossRefPubMedPubMedCentral Delforge M, Shah N, Miguel JSF, Braverman J, Dhanda DS, Shi L, et al. Health-related quality of life with idecabtagene vicleucel in relapsed and refractory multiple myeloma. Blood Adv. 2022;6(4):1309–18.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Mohyuddin GR, Koehn K, Abdallah AO, Goodman AM, Prasad V. Reporting of postprotocol therapies and attrition in multiple myeloma randomized clinical trials: a systematic review. JAMA Netw Open. 2021;4(4):e218084.CrossRefPubMedPubMedCentral Mohyuddin GR, Koehn K, Abdallah AO, Goodman AM, Prasad V. Reporting of postprotocol therapies and attrition in multiple myeloma randomized clinical trials: a systematic review. JAMA Netw Open. 2021;4(4):e218084.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Mohyuddin GR, Mian H. Daratumumab in newly diagnosed MM - incorporating lessons learnt from CASSIOPEIA, MAIA and beyond. Nat Rev Clin Oncol. 2022;19(1):3–4.CrossRefPubMed Mohyuddin GR, Mian H. Daratumumab in newly diagnosed MM - incorporating lessons learnt from CASSIOPEIA, MAIA and beyond. Nat Rev Clin Oncol. 2022;19(1):3–4.CrossRefPubMed
25.
Zurück zum Zitat Oerlemans S, Bennink MC, Levin MD, Broijl A, Van der Klift M, Van Deursen J, et al. Development of a patient centered outcome set for patients with multiple myeloma to be used in clinical practice. Hemasphere. 2020;4(3):e366.CrossRefPubMedPubMedCentral Oerlemans S, Bennink MC, Levin MD, Broijl A, Van der Klift M, Van Deursen J, et al. Development of a patient centered outcome set for patients with multiple myeloma to be used in clinical practice. Hemasphere. 2020;4(3):e366.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Witte J, Mehlis K, Surmann B, Lingnau R, Damm O, Greiner W, et al. Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications. Ann Oncol. 2019;30(7):1061–70.CrossRefPubMedPubMedCentral Witte J, Mehlis K, Surmann B, Lingnau R, Damm O, Greiner W, et al. Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications. Ann Oncol. 2019;30(7):1061–70.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Huntington SF, Weiss BM, Vogl DT, Cohen AD, Garfall AL, Mangan PA, et al. Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. Lancet Haematol. 2015;2(10):e408–16.CrossRefPubMed Huntington SF, Weiss BM, Vogl DT, Cohen AD, Garfall AL, Mangan PA, et al. Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. Lancet Haematol. 2015;2(10):e408–16.CrossRefPubMed
28.
Zurück zum Zitat Wesson W, Galate VL, Sborov DW, McClune B, Goodman AM, Gyawali B, et al. Characteristics of clinical trials for haematological malignancies from 2015 to 2020: a systematic review. Eur J Cancer. 2022;167:152–60.CrossRefPubMed Wesson W, Galate VL, Sborov DW, McClune B, Goodman AM, Gyawali B, et al. Characteristics of clinical trials for haematological malignancies from 2015 to 2020: a systematic review. Eur J Cancer. 2022;167:152–60.CrossRefPubMed
29.
Zurück zum Zitat Moreau P, Rajkumar SV. Multiple myeloma--translation of trial results into reality. Lancet. 2016;388(10040):111–3.CrossRefPubMed Moreau P, Rajkumar SV. Multiple myeloma--translation of trial results into reality. Lancet. 2016;388(10040):111–3.CrossRefPubMed
30.
Zurück zum Zitat Mohyuddin GR, Koehn K, Sborov D, McClune B, Abdallah AO, Goodman AM, et al. Quality of control groups in randomised trials of multiple myeloma enrolling in the USA: a systematic review. Lancet Haematol. 2021;8(4):e299–304.CrossRefPubMed Mohyuddin GR, Koehn K, Sborov D, McClune B, Abdallah AO, Goodman AM, et al. Quality of control groups in randomised trials of multiple myeloma enrolling in the USA: a systematic review. Lancet Haematol. 2021;8(4):e299–304.CrossRefPubMed
31.
Zurück zum Zitat Unprecedented outcomes of Isatuximab [press release]. Unprecedented outcomes of Isatuximab [press release].
32.
Zurück zum Zitat Antonanzas F, Terkola R, Postma M. The value of medicines: a crucial but vague concept. Pharmacoeconomics. 2016;34(12):1227–39.CrossRefPubMed Antonanzas F, Terkola R, Postma M. The value of medicines: a crucial but vague concept. Pharmacoeconomics. 2016;34(12):1227–39.CrossRefPubMed
33.
Zurück zum Zitat Tefferi A, Kantarjian H, Rajkumar SV, Baker LH, Abkowitz JL, Adamson JW, et al. In support of a patient-driven initiative and petition to lower the high price of cancer drugs. Mayo Clin Proc. 2015;90(8):996–1000.CrossRefPubMed Tefferi A, Kantarjian H, Rajkumar SV, Baker LH, Abkowitz JL, Adamson JW, et al. In support of a patient-driven initiative and petition to lower the high price of cancer drugs. Mayo Clin Proc. 2015;90(8):996–1000.CrossRefPubMed
34.
Zurück zum Zitat How a drugmaker gamed the system to keep generic competition away. How a drugmaker gamed the system to keep generic competition away.
35.
Zurück zum Zitat Facon T, Kumar S, Plesner T, Orlowski RZ, Moreau P, Bahlis N, et al. Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. N Engl J Med. 2019;380(22):2104–15.CrossRefPubMed Facon T, Kumar S, Plesner T, Orlowski RZ, Moreau P, Bahlis N, et al. Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. N Engl J Med. 2019;380(22):2104–15.CrossRefPubMed
36.
Zurück zum Zitat Kapoor P, Rajkumar SV. MAIA under the microscope - bringing trial design into focus. Nat Rev Clin Oncol. 2019;16(6):339–40.CrossRefPubMed Kapoor P, Rajkumar SV. MAIA under the microscope - bringing trial design into focus. Nat Rev Clin Oncol. 2019;16(6):339–40.CrossRefPubMed
37.
Zurück zum Zitat Moreau P, Sonneveld P, Investigators ftCS. Daratumumab (DARA) maintenance or observation (OBS) after treatment with bortezomib, thalidomide and dexamethasone (VTd) with or without DARA and autologous stem cell transplant (ASCT) in patients (pts) with newly diagnosed multiple myeloma (NDMM): CASSIOPEIA Part 2. J Clin Oncol. 2021;39(15_suppl):8004.CrossRef Moreau P, Sonneveld P, Investigators ftCS. Daratumumab (DARA) maintenance or observation (OBS) after treatment with bortezomib, thalidomide and dexamethasone (VTd) with or without DARA and autologous stem cell transplant (ASCT) in patients (pts) with newly diagnosed multiple myeloma (NDMM): CASSIOPEIA Part 2. J Clin Oncol. 2021;39(15_suppl):8004.CrossRef
38.
Zurück zum Zitat Munshi NC, Avet-Loiseau H, Anderson KC, Neri P, Paiva B, Samur M, et al. A large meta-analysis establishes the role of MRD negativity in long-term survival outcomes in patients with multiple myeloma. Blood Adv. 2020;4(23):5988–99.CrossRefPubMedPubMedCentral Munshi NC, Avet-Loiseau H, Anderson KC, Neri P, Paiva B, Samur M, et al. A large meta-analysis establishes the role of MRD negativity in long-term survival outcomes in patients with multiple myeloma. Blood Adv. 2020;4(23):5988–99.CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat Costa LJ, Derman BA, Bal S, Sidana S, Chhabra S, Silbermann R, et al. International harmonization in performing and reporting minimal residual disease assessment in multiple myeloma trials. Leukemia. 2021;35(1):18–30.CrossRefPubMed Costa LJ, Derman BA, Bal S, Sidana S, Chhabra S, Silbermann R, et al. International harmonization in performing and reporting minimal residual disease assessment in multiple myeloma trials. Leukemia. 2021;35(1):18–30.CrossRefPubMed
40.
Zurück zum Zitat Costa LJ, Chhabra S, Medvedova E, Dholaria BR, Schmidt TM, Godby KN, et al. Daratumumab, carfilzomib, lenalidomide, and dexamethasone with minimal residual disease response-adapted therapy in newly diagnosed multiple myeloma. J Clin Oncol 2021 JCO2101935. Costa LJ, Chhabra S, Medvedova E, Dholaria BR, Schmidt TM, Godby KN, et al. Daratumumab, carfilzomib, lenalidomide, and dexamethasone with minimal residual disease response-adapted therapy in newly diagnosed multiple myeloma. J Clin Oncol 2021 JCO2101935.
41.
Zurück zum Zitat Ray A, Ravillah D, Das DS, Song Y, Nordstrom E, Gullbo J, et al. A novel alkylating agent Melflufen induces irreversible DNA damage and cytotoxicity in multiple myeloma cells. Br J Haematol. 2016;174(3):397–409.CrossRefPubMedPubMedCentral Ray A, Ravillah D, Das DS, Song Y, Nordstrom E, Gullbo J, et al. A novel alkylating agent Melflufen induces irreversible DNA damage and cytotoxicity in multiple myeloma cells. Br J Haematol. 2016;174(3):397–409.CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Olivier T, Prasad V. The approval and withdrawal of melphalan flufenamide (melflufen): Implications for the state of the FDA. Transl Oncol. 2022;18:101374.CrossRefPubMedPubMedCentral Olivier T, Prasad V. The approval and withdrawal of melphalan flufenamide (melflufen): Implications for the state of the FDA. Transl Oncol. 2022;18:101374.CrossRefPubMedPubMedCentral
43.
Zurück zum Zitat Ehrhardt S, Appel LJ, Meinert CL. Trends in National Institutes of Health funding for clinical trials registered in ClinicalTrials.gov. JAMA. 2015;314(23):2566–7.CrossRefPubMedPubMedCentral Ehrhardt S, Appel LJ, Meinert CL. Trends in National Institutes of Health funding for clinical trials registered in ClinicalTrials.gov. JAMA. 2015;314(23):2566–7.CrossRefPubMedPubMedCentral
44.
Zurück zum Zitat Abola MV, Prasad V. Characteristics and conflicts of public speakers at Meetings of the Oncologic Drugs Advisory Committee to the US Food and Drug Administration. JAMA Intern Med. 2016;176(3):389–91.CrossRefPubMed Abola MV, Prasad V. Characteristics and conflicts of public speakers at Meetings of the Oncologic Drugs Advisory Committee to the US Food and Drug Administration. JAMA Intern Med. 2016;176(3):389–91.CrossRefPubMed
45.
Zurück zum Zitat Wayant C, Turner E, Meyer C, Sinnett P, Vassar M. Financial conflicts of interest among oncologist authors of reports of clinical drug trials. JAMA Oncol. 2018;4(10):1426–8.CrossRefPubMedPubMedCentral Wayant C, Turner E, Meyer C, Sinnett P, Vassar M. Financial conflicts of interest among oncologist authors of reports of clinical drug trials. JAMA Oncol. 2018;4(10):1426–8.CrossRefPubMedPubMedCentral
47.
Zurück zum Zitat Fischer KA, Walling A, Wenger N, Glaspy J. Cost health literacy as a physician skill-set: the relationship between oncologist reported knowledge and engagement with patients on financial toxicity. Support Care Cancer. 2020;28(12):5709–15.CrossRefPubMed Fischer KA, Walling A, Wenger N, Glaspy J. Cost health literacy as a physician skill-set: the relationship between oncologist reported knowledge and engagement with patients on financial toxicity. Support Care Cancer. 2020;28(12):5709–15.CrossRefPubMed
48.
Zurück zum Zitat Tao DL, Boothby A, McLouth J, Prasad V. Financial conflicts of interest among hematologist-oncologists on Twitter. JAMA Intern Med. 2017;177(3):425–7.CrossRefPubMed Tao DL, Boothby A, McLouth J, Prasad V. Financial conflicts of interest among hematologist-oncologists on Twitter. JAMA Intern Med. 2017;177(3):425–7.CrossRefPubMed
Metadaten
Titel
Value in Myeloma Care: Myth or Reality
verfasst von
Evguenia Ouchveridze
Katherine Berger
Ghulam Rehman Mohyuddin
Publikationsdatum
30.08.2022
Verlag
Springer US
Erschienen in
Current Hematologic Malignancy Reports / Ausgabe 6/2022
Print ISSN: 1558-8211
Elektronische ISSN: 1558-822X
DOI
https://doi.org/10.1007/s11899-022-00669-1

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