Therapeutic Options in the Treatment of Multiple Myeloma: Pharmacoeconomic and Quality-of-Life Considerations
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Abstract
A review of current treatment options in multiple myeloma is presented, including data on health-related quality of life and pharmacoeconomics. For induction chemotherapy, no combination of cytostatic drugs has been shown to be consistently superior to the simple cyclic oral treatment with melphalan and prednisone that has been available for 30 years. The total resource consumption and direct costs per patient treated with melphalan and prednisone is approximately US10000(1995values).Asmediansurvivalisprolongedfromlessthanayearinuntreatedpatientsto30to36months,thistreatmentmustbeconsideredcosteffective.Interferonβalphahasamodesteffectonprogressionβfreeandoverallsurvivalwhenaddedtochemotherapyregimens.However,thehighcostandtoxicityofthisdrugresultsinanunfavourablecostβutilityratio,estimatedtobebetweenUS50 000 to US100000perqualityβadjustedlifeβyeargained.Clinicaltrialssuggestthathighdosechemotherapyfollowedbyautologousstemcellsupportadministeredtopatientswhohaveachieveddiseasestabilisationorobjectiveresponsetoconventionalinductionchemotherapy,prolongsmediansurvivalbyabout1.5years.PreliminarycostβutilityanalysessuggestacostperlifeβyeargainedofUS30 000 to $US40 000. Further potential improvements of this therapeutic modality are under way. Several bisphosphonates have been tested for the ability to prevent the skeletal complications of multiple myeloma. Monthly infusions of pamidronate have been shown in 1 randomised trial to significantly reduce the rate of skeletal complications. Unfortunately, the rapid and widespread acceptance of this therapy seems to preclude further prospective, placebo-controlled trials with cost-utility evaluation.Reviews-on-treatment, Multiple-myeloma, Antineoplastics, Interferon-alpha, Stem-cell-transplant, Cost-analysis, Bone-marrow-transplant, Cost-analysis, Quality-of-life, Immunoglobulins, Epoetin-alfa, Bisphosphonates