The role of private insurance characteristics in the out-of-pocket costs of patients with multiple myeloma.

Hamlet Gasoyan Cleveland Clinic, Cleveland, OH info_outline Hamlet Gasoyan, Michael B. Rothberg

Authors Hamlet Gasoyan Cleveland Clinic, Cleveland, OH info_outline Hamlet Gasoyan, Michael B. Rothberg Organizations Cleveland Clinic, Cleveland, OH Abstract Disclosures Research Funding Other Dr. Hamlet Gasoyan received support from the Cancer Intervention and Surveillance Modeling Network’s Junior Investigator Career Enhancement Research Award Background: Over the past two decades, the major advances in the treatment of multiple myeloma have improved overall survival considerably. High costs of novel medications and patient out-of-pocket costs were suggested to have a role in treatment disparities but available data on total- and patient-out-of-pocket costs are dated. We examined the costs in privately insured patients with newly diagnosed multiple myeloma in the first year after the diagnosis, based on insurance plan characteristics. Methods: This retrospective study used the IBM MarketScan Commercial Database for the years 2011–2019, which consists of medical and prescription medications data from 120+ large employers and 40+ health plans in the US. The primary outcome variables were total- and patient out-of-pocket costs during 1 year after the index diagnosis. Results: 5,487 privately insured adults with an index multiple myeloma diagnosis during 2012-2018 were identified. Approximately 41% (n=2,240) of the study population received bortezomib, 38.6% (n=2,117) received lenalidomide, and 5.7% (n=314) received carfilzomib during 1 year after the index diagnosis. The median total cost of care in the first year after multiple myeloma diagnosis increased from $133,938 (interquartile range, $19,770 – $292,501, expressed in 2018 USD) in patients diagnoses in 2012 to $252,559 ($33,089 – $380,662) in patients diagnoses in 2018. The median patient out-of-pocket costs were $3,147 (interquartile range $1,562 - $5,441, 2018 USD) in patients diagnosed in 2012 and $3,711 ($1,756 – $6,466) in patients diagnosed in 2018. Among patients diagnosed in 2018, the median patient out-of-pocket cost was $1,706 ($902 – $2,873) for patients with low out-of-pocket cost plans, $3,428 ($1,794 – $6,371) for those with average out-of-pocket cost plans, and $5,623 ($3,517 - $7,810) for patients with high out-of-pocket cost plans. Conclusions: While the total cost of care in the first year after multiple myeloma almost doubled during the study period, the patient out-of-pocket costs remained relatively stable. The protections imposed by the Affordable Care Act are likely key in preventing surges in patient out-of-pocket costs. Additional legislative action could help curb the price increases for multiple myeloma medications. Costs during one year after multiple myeloma diagnosis, n=5,409. Year 2012 2013 2014 2015 2016 2017 2018 Median Out-Of-Pocket Cost (Interquartile Range) 3,147 (1,562 - 5,441) 3,505 (1,708 - 5,565) 2,915 (1,464 - 5,099) 2,884 (1,531 - 5,181) 3,363 (1,576 - 5,618) 3,132 (1,483 - 5,299) 3,711 (1,756 - 6,466) Median Total Cost (Interquartile Range) 133,938 (19,770 - 292,501) 151,713 (27,392 - 297,279) 126,898 (20,134 - 291,692) 161,508 (19,420 - 333,108) 201,603 (27,291 - 350,144) 175,070 (19,831- 340,040) 252,559 (33,089- 380,662) Costs pooled from different years were expressed in 2018 US dollars, using the Consumer Price Index.