The diagnosis and care for older patients with multiple myeloma (MM) was associated with substantial burden for persons covered by fee-for-service Medicare, indicating a need for alternative payment models. These findings were published in JAMA Network Open.

To assess the MM-specific costs among older adults covered by Medicare, researchers from University of Mississippi School of Pharmacy analyzed data from the 2007-2015 Surveillance, Epidemiology, and End Results registry.

Cohorts of 4533 matched pairs of patients with MM and noncancer diagnoses were included. The MM cohort comprised 52.4% women, mean age 75.8±6.8 years, and 75.4% were White.

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During the disease lifetime, the MM cohort associated with significantly higher costs compared with the noncancer cohort (mean, $212,474.70 vs $54,085.60; P <.001) and specifically during the prediagnosis (mean, $2080.90 vs $1566.80; P <.001), initial care (mean, $10,384.50 vs $1618.20; P <.001), continuing care (mean, $6082.80 vs $1495.00; P <.001), and terminal care (mean, $14,417.00 vs $8853.10; P <.001) phases.

Compared with the control group, the median incremental cost of MM per member per month was $1244 for the prediagnosis; $11,181 for the initial; $5634 for the continuing; and $6280 for the terminal phases, or $184,495 for the disease lifetime.

The proportion of costs differed on the basis of care stage, in which inpatient care was the most costly during the prediagnosis and initial care phases, pharmacy costs were highest during the continuing care phase, and outpatient costs were most costly during the terminal phase.

This study was limited by only including claims among Medicare recipients, it remains unclear whether these findings were generalizable to other insurers.

These data indicated there was a substantial economic burden associated with MM among patients covered by Medicare and that alternative payment options or phase-specific payment bundles are needed to reduce financial burden.

Disclosure: One author declared affiliations with biotech, pharmaceutical, or device companies. Please see the original article for a full list of authors’ disclosures.


Bhattacharya K, Bentley JP, Ramachandran S, et al. Phase-specific and lifetime costs of multiple myeloma among older adults in the US. JAMA Netw Open. 2021;4(7):e2116357. doi:10.1001/jamanetworkopen.2021.16357