Patients with newly diagnosed multiple myeloma (NDMM) who experience skeletal-related events (SREs) accumulate more than double the all-cause health care costs than matched patients with NDMM without SREs. Furthermore, healthcare costs increase in proportion to the number of SREs. These study findings were published in the Journal of Oncology Pharmacy Practice.

Although median overall survival has improved substantially for patients with MM, the disease remains incurable. More than 80% of patients with MM have osteolytic bone disease, which is a predictor of morbidity, mortality, and decreased quality of life. Skeletal-related events, a complication of osteolytic bone disease, are defined as pathological fractures, hypercalcemia, and spinal cord compression, and undergoing radiation to bone and surgery to bone.

In this study, researchers used IBM MarketScan administrative claims to identify adult patients with NDMM between January 2006 and June 2017. Patients had a minimum of 12 months of continuous health coverage before diagnosis, and those with SREs were propensity-score matched to patients without SREs.

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Prior to matching, the 6648 patients in the SRE arm had more comorbidities, were more likely to have treatment for MM, and had increased pre-index health care costs, compared with the 7458 patients in the non-SRE arm.

Matching for well-balanced baseline characteristics yielded cohorts of 3432 patients for comparative analysis. From this, results indicated that patients with SREs accrued significantly higher outpatient, inpatient, and pharmacy healthcare resource utilization compared with patients without SREs.

The average annual all-cause health care cost for patients with SREs was $213,361, whereas the cost for patients without SREs was $94,896 (P <.001). At 38.7% of the total cost, hospitalization was the leading driver of increased costs.

Health care costs also increased in proportion to the number of SREs. Across all 6648 patients with SREs, the average annual SRE-related health care costs were $39,603 for patients with 1 SRE; $45,463 for those with 2 SREs; and $50,111 for those with 3 SREs. For each group of total number of SREs, inpatient services comprised the majority of the health care expenses.

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The authors noted that these results indicate under-utilization of prophylactic treatment of SREs. “Concurrent management of bone complications with approved therapies as well as evidence-based management of the MM with the most effective therapies early in the disease life-cycle itself might be the key to management of SREs in this so far incurable and chronic malignancy,” they concluded.


Ailawadhi S, Medhekar R, Princic N, et al. Healthcare resource utilization and costs in patients with multiple myeloma with and without skeletal-related events [published online October 20, 2019]. J Oncol Pharm Pract. doi: 10.1177/1078155219881489