Economic and clinical impact of multiple myeloma to managed care
Economic and clinical impact of multiple myeloma to managed care
复制标题
DOI：
10.18553/jmcp.2008.14.s7-a.19
复制
发表时间：
2008-09-01
影响因子：
--
通讯作者：
Cook, Richard
中科院分区：
文献类型：
--
作者：
Cook, Richard
背景：由于免疫调节剂、蛋白酶体抑制剂和双磷酸盐等新型药物的发展，多发性骨髓瘤(MM)患者的护理标准发生了变化。与现有和新兴疗法以及支持性护理相关的成本是巨大的，对患者和管理的护理都构成了巨大的经济负担。目的：回顾MM的经济影响，并权衡现有治疗在延长生命价值方面的优势和劣势与治疗成本。本章还将讨论彻底的数据审查和药物经济学分析的必要性，以确定最具成本效益的治疗方法。总结：尽管MM只占所有癌症类型的一小部分，但与治疗和管理它相关的成本是最高的之一。在诊断、治疗和治疗骨髓瘤方面的最新进展导致了新的治疗策略。免疫调节剂、蛋白酶体抑制剂和双膦酸盐正在提高应答率和保持生活质量。然而，这些药物并不是在取代旧的治疗方式，而是在它们之外使用。强化化疗、干细胞移植和支持性护理都是实现治疗目标的重要组成部分。与干细胞移植相关的费用和疾病的并发症增加了骨髓瘤的经济负担。需要考虑常规诊断的额外费用，以衡量疾病的进展或对治疗的反应。并发症(如溶骨病、感染、贫血和肾功能衰竭)也增加了发病率和死亡率，从而增加了患者和整个卫生保健系统的负担。还必须考虑照顾者的经济和时间限制，以及卫生保健提供者增加的行政负担。结论：骨髓瘤治疗和管理的新护理标准可能会导致成本的显著增加。尽管成本不是唯一要考虑的因素，但它们在管理这种本已代价高昂的疾病方面至关重要。骨髓瘤治疗和支持性护理的所有方面都必须进行评估和分析。药品成本不能单独成为治疗决定的驱动因素。经济分析可以用来证明，最便宜的替代方案并不总是最经济的，而且它可能不会对医疗计划和患者都产生最佳结果。虽然成本控制显然是一个重要的目标，但医疗质量是第一优先事项，管理型医疗组织面临着平衡成本和效益评估的挑战。
BACKGROUND: Because of the development of novel agents such as immunomodulators, proteasome inhibitors, and bisphosphonates, the standards of care for the multiple myeloma (MM) patient have changed. The costs associated with current and emerging therapies, as well as supportive care, are significant and pose a tremendous financial burden to both patients and managed care.OBJECTIVE: To review the economic impact of MM and to weigh the advantages and disadvantages of current treatments in bringing value for prolonged life versus the cost of treatment. This chapter will also discuss the need for thorough data review and pharmacoeconomic analyses to determine the most cost-effective therapies.SUMMARY: Although MM accounts for only a small percentage of all cancer types, the costs associated with treating and managing it are among the highest. Recent developments in diagnosing, treating, and managing myeloma have led to novel treatment strategies. Immunomodulators, proteasome inhibitors, and bisphosphonates are improving response rates and preserving quality of life. However, these agents are not replacing older treatment modalities, but being used in addition to them. Intensive chemotherapy, stem cell transplantation, and supportive care are all important components in achieving treatment goals.Costs associated with stem cell transplants and complications of the disease add to the economic burden of myeloma. Additional costs for routine diagnostics to measure the progression of the disease or response to treatment need to be considered. Complications (e.g., lytic bone disease, infection, anemia, and renal failure) also add to morbidity and mortality, thus increasing the burden to the patient and the health care system as a whole.Financial and time constraints of caregivers must also be considered, as well as the added administrative burdens to health care providers.CONCLUSION: New standards of care in the treatment and management of myeloma are likely to lead to significant increases in costs. Although costs are not the only elements to be considered, they are crucial in the management of this already costly disease. All aspects of myeloma treatment and supportive care must be evaluated and analyzed. Cost of pharmaceuticals alone must not be a driving factor in treatment decisions. Economic analyses can be used to demonstrate that the least expensive alternative is not always the most economical, and that it may not produce an optimal outcome for both the health plan and the patient. Although cost containment is clearly an important objective, quality of care is the first priority, and managed care organizations have the challenge of making balanced cost and benefit assessments.