Value and Cost of Myeloma Therapy

The treatment of multiple myeloma has improved significantly over the past 10 to 15 years, more than doubling the overall survival of the disease.1,2 In the recent IFM trial, the 4-year survival rate of patients with myeloma was 82% using standard therapy with bortezomib, lenalidomide, and dexamethasone, autologous stem cell transplantation, and lenalidomide maintenance.3 In fact, even these results underestimate what is possible today, as they do not take into account the arrival of the monoclonal antibodies daratumumab and elotuzumab.4 However, modern treatments are useful only if patients in the real world have access to them. The standard initial therapy available to well-insured patients in the United States (bortezomib, lenalidomide, and dexamethasone) is not available to most newly diagnosed patients in most countries. Regulatory barriers aside, an important factor that prevents access is the prohibitive cost of most myeloma drugs.5 Even when access is not a problem, and when out-of-pocket costs are almost completely covered by private insurance or the public health system, the high costs are not sustainable for any country.6-8 Table 1 lists the annual cost of myeloma therapy for each active drug. Because myeloma therapy is mostly administered as a combination of three or more drugs, the costs of common combinations are also provided. The information presented needs no explanation or justification: it speaks for itself. Patients with myeloma are treated for years in a continuous manner. With median survival in excess of 7 to 10 years, one can do the math in terms of cost. Myeloma is a great example of a problem that plagues all cancers.5 Almost every approved new cancer drug costs more than $100,000 per year in the United States.9,10 Although this article is focused on the cost of myeloma drugs, clearly there are other issues that must be addressed, including the cost of laboratory workup and imaging, physician visits, chemotherapy administration, hospital charges, and so on. TABLE 1. Cost of Myeloma Drugs and Regimens TABLE 1.Cost of Myeloma Drugs and Regimens View larger version (264K) WHY ARE CANCER DRUGS SO EXPENSIVE? Section: ChooseTop of pageAbstractWHY ARE CANCER DRUGS SO E... <