Health system costs and autologous stem cell transplant receipt for participants with multiple myeloma in the Australian 45 and Up Study

Abstract

Background

In Australia, the number of people living with multiple myeloma (MM) is projected to increase. We examined the health system costs and autologous stem cell transplant (ASCT) receipt among participants with MM diagnosed between 2006 and 2019 from the Australian 45 and Up Study cohort (267,357 participants).

Materials and methods

We identified 520 participants diagnosed with MM using cancer registry records. Direct excess health system costs were calculated by subtracting the mean values observed for 2533 matched participants without cancer from those observed for participants with MM. Costs were calculated from 2 years pre-diagnosis up to 5 years post-diagnosis, for different phases of care and at end of life. Participant characteristics associated with health system costs were analysed using gamma regression. Characteristics associated with ASCT receipt were analysed using competing risks regression.

Results

Mean excess health system cost per person was $8846 in the year pre-diagnosis and peaked at $66,249 in the year post-diagnosis. From 2- to 5-years post-diagnosis, mean excess costs per person ranged between $36,453 and $43,059 and remained substantially higher than pre-diagnosis levels. Within the 5-years post-diagnosis, 125 (24.0 %) received ASCT. Older age at diagnosis was strongly associated with lower costs (each one-year increase, relative rate (RR)= 0.97, 95 % CI:0.96–0.98 for initial phase of care costs) and a lower rate of ASCT (each one-year increase, sub-hazard ratio (SHR)= 0.85, 95 % CI:0.83–0.87).

Conclusions

Health system costs for individuals with MM were significantly higher post-diagnosis than pre-diagnosis and remained elevated for at least 5-years. This work provides insights for future healthcare requirements for MM.