Treatment sequences and drug costs from diagnosis to death in multiple myeloma

Novel therapies for multiple myeloma (MM) have improved patient survival, but their high costs strain healthcare budgets. End-of-life phases of treatment are generally the most expensive, however, these high costs may be less justifiable in the context of a less pronounced clinical benefit. To manage drug expenses effectively, detailed information on end-of-life drug administration and costs are crucial. In this retrospective study, we analysed treatment sequences and drug costs from 96 MM patients in the Netherlands who died between January 2017 and July 2019. Patients received up to 16 lines of therapy (median overall survival: 56.5 months), with average lifetime costs of €209 871 (€3111/month; range: €3942–€776 185) for anti-MM drugs. About 85% of patients received anti-MM treatment in the last 3 months before death, incurring costs of €20 761 (range: €70–€50 122; 10% of total). Half of the patients received anti-MM treatment in the last 14 days, mainly fully oral regimens (66%). End-of-life treatment costs are substantial despite limited survival benefits. The use of expensive treatment options is expected to increase costs further. These data serve as a reference point for future cost studies, and further research is needed to identify factors predicting the efficacy and clinical benefit of continuing end-of-life therapy.</p

Quality of life gains in frail and intermediate-fit patients with multiple Myeloma:Findings from the prospective HOVON123 clinical trial

Background: Frailty in newly-diagnosed multiple myeloma (NDMM) patients is associated with treatment-related toxicity, which negatively affects health-related quality of life (HRQoL). Currently, data on changes in HRQoL of frail and intermediate-fit MM patients during active treatment and post-treatment follow-up are absent. Methods: The HOVON123 study (NTR4244) was a phase II trial in which NDMM patients ≥ 75 years were treated with nine dose-adjusted cycles of Melphalan-Prednisone-Bortezomib (MPV). Two HRQoL instruments (EORTC QLQ-C30 and -MY20) were obtained before start of treatment, after 3 and 9 months of treatment and 6 and 12 months after treatment for patients who did not yet start second-line treatment. HRQoL changes and/or differences in frail and intermediate-fit patients (IMWG frailty score) were reported only when both statistically significant (p &lt; 0.005) and clinically relevant (&gt;MID). Results: 137 frail and 71 intermediate-fit patients were included in the analysis. Compliance was high and comparable in both groups. At baseline, frail patients reported lower global health status, lower physical functioning scores and more fatigue and pain compared to intermediate-fit patients. Both groups improved in global health status and future perspective; polyneuropathy complaints worsened over time. Frail patients improved over time in physical functioning, fatigue and pain. Improvement in global health status occurred earlier than in intermediate-fit patients. Conclusion: HRQoL improved during anti-myeloma treatment in both intermediate-fit and frail MM patients. In frail patients, improvement occurred faster and, in more domains, which was retained during follow-up. This implies that physicians should not withhold safe and effective therapies from frail patients in fear of HRQoL deterioration.</p

Rituximab in B-Cell Hematologic Malignancies: A Review of 20 Years of Clinical Experience

Rituximab is a human/murine, chimeric anti-CD20 monoclonal antibody with established efficacy, and a favorable and well-defined safety profile in patients with various CD20-expressing lymphoid malignancies, including indolent and aggressive forms of B-cell non-Hodgkin lymphoma. Since its first approval 20 years ago, intravenously administered rituximab has revolutionized the treatment of B-cell malignancies and has become a standard component of care for follicular lymphoma, diffuse large B-cell lymphoma, chronic lymphocytic leukemia, and mantle cell lymphoma. For all of these diseases, clinical trials have demonstrated that rituximab not only prolongs the time to disease progression but also extends overall survival. Efficacy benefits have also been shown in patients with marginal zone lymphoma and in more aggressive diseases such as Burkitt lymphoma. Although the proven clinical efficacy and success of rituximab has led to the development of other anti-CD20 monoclonal antibodies in recent years (e.g., obinutuzumab, ofatumumab, veltuzumab, and ocrelizumab), rituximab is likely to maintain a position within the therapeutic armamentarium because it is well established with a long history of successful clinical use. Furthermore, a subcutaneous formulation of the drug has been approved both in the EU and in the USA for the treatment of B-cell malignancies. Using the wealth of data published on rituximab during the last two decades, we review the preclinical development of rituximab and the clinical experience gained in the treatment of hematologic B-cell malignancies, with a focus on the well-established intravenous route of administration. This article is a companion paper to A. Davies, et al., which is also published in this issue

Australia: A Continent Without Native Powdery Mildews? The First Comprehensive Catalog Indicates Recent Introductions and Multiple Host Range Expansion Events, and Leads to the Re-discovery of Salmonomyces as a New Lineage of the Erysiphales

In contrast to Eurasia and North America, powdery mildews (Ascomycota, Erysiphales) are understudied in Australia. There are over 900 species known globally, with fewer than currently 60 recorded from Australia. Some of the Australian records are doubtful as the identifications were presumptive, being based on host plant-pathogen lists from overseas. The goal of this study was to provide the first comprehensive catalog of all powdery mildew species present in Australia. The project resulted in (i) an up-to-date list of all the taxa that have been identified in Australia based on published DNA barcode sequences prior to this study; (ii) the precise identification of 117 specimens freshly collected from across the country; and (iii) the precise identification of 30 herbarium specimens collected between 1975 and 2013. This study confirmed 42 species representing 10 genera, including two genera and 13 species recorded for the first time in Australia. In Eurasia and North America, the number of powdery mildew species is much higher. Phylogenetic analyses of powdery mildews collected from Acalypha spp. resulted in the transfer of Erysiphe acalyphae to Salmonomyces, a resurrected genus. Salmonomyces acalyphae comb. nov. represents a newly discovered lineage of the Erysiphales. Another taxonomic change is the transfer of Oidium ixodiae to Golovinomyces. Powdery mildew infections have been confirmed on 13 native Australian plant species in the genera Acacia, Acalypha, Cephalotus, Convolvulus, Eucalyptus, Hardenbergia, Ixodia, Jagera, Senecio, and Trema. Most of the causal agents were polyphagous species that infect many other host plants both overseas and in Australia. All powdery mildews infecting native plants in Australia were phylogenetically closely related to species known overseas. The data indicate that Australia is a continent without native powdery mildews, and most, if not all, species have been introduced since the European colonization of the continent

Ondersoekings in verband met bone (Phaseolus vulgaris)

Proefskrif (M. Sc. Agric.) -- Universiteit van Stellenbosch, 1945.Full text to be digitised and attached to bibliographic record

A survey of applications and requirements of unique identification systems and RFID techniques

The paper contains an overview of unique identification issues and of the various radio frequency identification techniques that are available now or will become available in the short term. The paper also compares REID with traditional ID technologies. It shows application possibilities and gives examples of current implementations. Each application has its own requirements that translate into specific REID-techniques, -options and -parameters. Techniques include frequency range, tag energy supply and tag writing capabilities. The data to be stored in the tag and transferred to the reader must be selected as one of the options. Parameters influence reliability and confidentiality, among other things. Information interchange issues of identifier-based operations in supply-chains are discussed as well, while the last part of the paper presents a framework for choosing an auto-ID technique in a supply chain. (C) 2010 Elsevier B.V. All rights reserved

High hospital-related burden of treatment for multiple myeloma patients: outcomes of a feasibility study using reimbursement data from electronic health records

Objective: Multiple Myeloma (MM) is an incurable plasma cell malignancy with intensive and prolonged treatment, presumably causing a considerable burden of treatment on patients. The concept of treatment burden is defined as the work of being a patient and its impact on well-being. However, there is no consistent definition and method to measure treatment burden in patients with MM. Therefore, the aim of this study was to determine the burden of treatment in MM patients and to compare it to Chronic Lymphoid Leukaemia (CLL). Methods: We conducted a retrospective analysis using reimbursement data from electronic health records (EHR) to calculate treatment burden. Treatment burden was defined as the number of hospital visits on unique days. After data clearance, data were analysed using descriptive statistics comparing treatment burden between different types of visits, age groups, years since diagnosis, and between MM and CLL patients. Results: Reimbursement data of 176 MM and 173 CLL patients were included in the analysis, which showed i) highest treatment burden in the first year immediately after diagnosis, ii) small differences between age groups (total visits year 0: 68.2 ≤ 65/63.8>65 years in MM and 21.7 ≤ 65/25.6>65 years in CLL), iii) higher treatment rates with more treatment burden in MM patients compared to CLL. Conclusion: EHR reimbursement data provided useful information to measure treatment burden and showed higher burden in MM patients compared to CLL patients. With improving survival, measuring burden of treatment in clinical practice in patients with MM contributes to decreasing treatment burden and more patient-centred care. Conclusion: EHR reimbursement data provided useful information to measure treatment burden and showed higher burden in MM patients compared to CLL patients. With improving survival, measuring burden of treatment in clinical practice in patients with MM contributes to decreasing treatment burden and more patient-centred care. Public interest summary: As in other malignant diseases, new treatment options dramatically improved survival in patients with multiple myeloma (MM). As a consequence, MM patients undergo intensive and intermittent periods of treatment, which causes a considerable burden of treatment. In this study we used data retrieved from Electronic Health Records (EHR) from 176 patients with MM and 173 patients with chronic lymphoid leukaemia (CLL) (both haematological diseases), to measure and analyse patients’ burden of undergoing treatment. The results showed that EHR-data provided useful information to determine treatment burden in patients and that treatment burden is considerably higher in patients with MM compared to CLL patients. Further development of this method makes it possible to frequently monitor and evaluate treatment burden. Eventually, this may help health care professionals to provide more patient-centred care and improve quality of life by reducing treatment burden

Medical Resource Use and Medical Costs for Radiotherapy-Related Adverse Effects: A Systematic Review

Background: Despite the need for a proper economic evaluation of new radiotherapies, the economic burden of radiotherapy-induced adverse effects remains unclear. A systematic review has been conducted to identify the existing evidence of healthcare resource use and costs related to radiotherapy-induced adverse effects and also to provide recommendations for including this evidence in economic evaluations. Methods: This systematic review of healthcare resource use and/or medical costs related to radiotherapy-induced adverse effects was performed up until 2020, focusing on patients with head and neck cancer, brain cancer, prostate cancer, eye cancer and breast cancer. Results: Resource use for treating the same adverse effects varied considerably across studies; for instance, the cost for mucositis ranged from USD 2949 to USD 17,244. This broad range could be related to differences in (1) severity of adverse effects in the study population, (2) study design, (3) cost estimation approach and (4) country and clinical practice. Conclusions: Our findings revealed unignorable differences for the same adverse effects, which implied that the potential for the economic burden of adverse effects was being overestimated or underestimated in economic evaluation for radiotherapy