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Cost of multiple myeloma treatment may cause ‘financial toxicity’
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The burden of out-of-pocket costs and expenses for patients with multiple myeloma appeared excessive and may lead to treatment delays or abandonment, according to results of a cross-sectional survey.
Due to the higher cost of new therapies and the length of treatment for myeloma, even patients with health insurance and high incomes face these “financial toxicities,” Scott Huntington, MD, a faculty member in the hematology program at Yale University and formerly of the division of hematology/oncology at University of Pennsylvania, and colleagues wrote.
Scott Huntington
“While advances in multiple myeloma therapy have contributed to significant improvements in patients outcomes, the clinical gains have come with rising costs,” Huntington said in a press release. “Today, because of these advances, most patients are on a new drug, compared to a decade ago when less than 5% were. So, we’re not talking about a select group of patients faced with this burden — many are facing the financial challenges with treatment.”
Huntington and colleagues conducted a cross-sectional survey of 100 patients who had received at least 3 months of ongoing treatment for multiple myeloma at a U.S. academic medical center between Aug. 18, 2014 and Jan. 7, 2015. Sixty-one percent of patients were receiving a novel oral myeloma agent at the time of the survey, and only 11% had never received a novel agent since diagnosis.
Every patient had health insurance (commercial, 43%, Medicare, 49%; Medicaid or dual, 8%). Further, the median household income of the cohort was above the national average (between $60,000 and $79,999) and 70% of the patients reported having some college education.
The survey included the 11-item comprehensive score for financial toxicity (COST) measure that provides a financial toxicity score ranging from 0 to 44. A score below the median (23) indicated greater financial toxicity.
Fifty-nine percent of the patients reported treatment costs as being higher than expected. Seventy-one percent of the patients reported at least one minor financial burden and 36% reported applying for financial assistance, 18% of whom reported an income of $100,000 or higher.
Patients commonly used their savings accounts to pay for myeloma treatment (46%), whereas 21% of the patients borrowed money to pay for their therapeutics. Additionally, 17% of the patients reported delays in their treatment because they couldn’t afford the costs.
Half of the patients either had to stop working (38%) or reduce their work hours (12%).
Eleven percent of the patients stopped their treatment because of the cost.
Patients with COST scores less than the median appeared more likely to reduce their spending on basic goods and leisure activities, use their savings for care, borrow money, delay treatment initiation due to finances, and stop treatment due to cost (P ˂ .01 for all).
On multivariable analysis, younger age (P = .00092), non-married status (P = .0074), time since diagnosis (P = .042) and household income (P ˂ .0001) appeared associated with lower COST scores and greater financial toxicity.
The researchers identified several study limitations, including the inability to define causal associations between cost and financial burden based on survey results. Additionally, the study did not include insurance claims or long-term follow-up data.
“While enthusiasm surrounding modern advancements in cancer treatment is warranted, we must also acknowledge the untenable rise in treatment costs and its impact on patients,” Huntington and colleagues wrote. “In the interim, strengthened collaboration among patients and health care stakeholders is needed to promote health care reforms that not only reward treatment innovation, but also promote high value and affordable cancer care.”
In an accompanying editorial, Jonas A. de Souza, MD, assistant professor of medicine at University of Chicago, and Lori Muffly, MD, clinical assistant professor of medicine and blood and bone marrow transplantation at Stanford University, called this study “timely and provocative.”
“Huntington and colleagues should be commended for several things,” they wrote. “First, the inclusion of patients with at least 3 months of ongoing multiple myeloma treatment ensured some experience with finances related to cancer. Second they not only included a patient-reported outcome measure, but also indicators of burden, such as the increased use of coping strategies …
“Also, the investigators call attention to the medication costs and intentionally excluded patients in clinical trials. Although drug costs are important and might indeed be the main driver of costs in multiple myeloma, loss of income due to disease might also have a role, especially in patients undergoing transplantation.” – by Anthony SanFilippo
Disclosure: Huntington reports stock ownership in Exelixis, Geron and OncoSec Medical. de Souza reports personal fees from AstraZeneca. Muffly reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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