Multiple Myeloma: The Rising Cost of Cancer Care

Written by Samantha Delios, MSc Candidate and TMED 801 Student
 

On February 9th, the Department of Medicine had the pleasure of hearing from a Queen’s Translational Medicine MSc alumni Dr. Bethany Monteith. Dr. Monteith is a clinician-scholar in hematology. She works on research including improving access to clinical trials for hematology patients and minimizing the cost of the delivery of care in this area. She is a staple in the field of multiple myeloma (MM) as her academic interests focus on cost-effectiveness analyses in MM.

Dr. Monteith discussed the rising cost of cancer care surrounding MM. MM is a cancer that forms within plasma cells. These cancer cells crowd out healthy blood cells and accumulate in bone marrow resulting in many diseases, infections, and bone marrow failure (anemia). Dr. Monteith began by discussing the incidence and prevalence of MM in Canada. This disease is the second most common hematologic malignancy in adults and represents 1.6% of all cancer diagnoses in Canada [1]. The incidence rate of MM and prevalence of cancer has been shown to increase due to the growing and aging population. Although the rate of living beyond your diagnosis is rising for many other cancer types, MM has a lower rate of success. In 2022, it is estimated that over 6050 Canadians will die from MM, however, the 5-year survival of MM went from 27% in 1992-94 to 50% in 2015-2017 [2].

Dr. Monteith discussed how due to advances in drug therapies, there has been an improvement in overall survival of multiple myeloma of over 20% during the last two decades. Drug therapies have advanced from using melphalan (with high-dose steroids) in the 1960s to using daratumumab (directed against CD38 glycoprotein) in 2015 [3]. There are various other drug therapies discussed that contribute to a large increase in overall survival. Dr. Monteith described treatment cycles of multiple myeloma and how there are now more relapses that can occur before the possibility of remission. (e.g. rather than having few relapses, patients will have 3 or 4). However, with these advances, expenses may rise as well.

Dr. Monteith discussed the cost of different therapies. She discussed how healthcare spending in Canada continues to rise (representing 12.2% of GDP in 2022). In Canada, about $193 billion was spent on cancer care in 2008 ($3.8 billion on malignant neoplasms) [4]. The cost of MM is also hard to come by as it has the highest net lifetime costs of all cancer disease sites in Ontario ($68,000 mean lifetime net cost at 5 years compared to 38,000 in other tumour sites) [4]. Dr. Monteith described an abstract that tested 7 different MM therapies. This study found that drug spending increased by 300% over 9 years, but the treatment volume only increased by 116% due to many new drug indications. Another Canadian study looked at MM drugs used in Canada and found a drug that is less expensive to use (Bortezomib) in replacement of lenalidomide which can be a cheaper therapeutic to consider for future patients [6].

Dr. Monteith discussed her own TMED master’s thesis which looked at the increase in toxicity and cost with new drug therapies to treat MM. Her thesis explained that the cost of high-dose wKCD (triplet regimen for RRMM) comes with potential cost savings of $104,663.43/pt from direct drug costs and $16,580.49/pt from drug administration costs in comparison to twice-weekly regimens [6]. This can be useful for therapeutic discovery for future patients. Dr. Monteith discussed how one way to minimize drug wastage is by choosing an optimal vial size. For example, lowering the dosage provided in each vile and vile size (as most drugs are only stable for 24 hours) could lead to $28,000 in savings.

Following her lecture, Dr. Monteith had a discussion with the TMED students to share how her research can be applied to translational medicine and patient care. Dr. Monteith discussed what she considered to be a promising therapeutic option to help lower the rising cost of cancer. Dr. Monteith also discussed how gaining financial assistance and community support from fundraisers can help raise positivity and lower the financial burden of this issue (such as the walk for the cure or donations like the Paula and Rodney association donating $9.2 million) [7]. Additionally, Dr. Monteith described being a woman in STEM and some of the current therapies she believes could help lower the cost and shape MM patient care in the future.
 

On behalf of the TMED class, I would like to thank Dr. Monteith for her educational discussion on the rising costs of MM.

References:

[1] Kazandjian, D. (2016, December). Multiple myeloma epidemiology and survival: A unique malignancy. In Seminars in oncology (Vol. 43, No. 6, pp. 676-681). WB Saunders.

[2] Ellison, L. F. (2018). Progress in net cancer survival in Canada over 20 years. Health reports, 29(9), 10-19.

[3] Lokhorst, H. M., Plesner, T., Laubach, J. P., Nahi, H., Gimsing, P., Hansson, M., ... & Richardson, P. G. (2015). Targeting CD38 with daratumumab monotherapy in multiple myeloma. New England Journal of Medicine, 373(13), 1207-1219.

[4] de Oliveira, C., Pataky, R., Bremner, K. E., Rangrej, J., Chan, K. K., Cheung, W. Y., ... & Krahn, M. D. (2016). Phase-specific and lifetime costs of cancer care in Ontario, Canada. BMC cancer, 16(1), 1-12.

[5] LeBlanc, R., Hollmann, S., & Tay, J. (2016). Canadian cost analysis comparing maintenance therapy with bortezomib versus lenalidomide for patients with multiple myeloma post autologous stem cell transplant. Journal of Population Therapeutics and Clinical Pharmacology, 23(1).

[6] Monteith, B. E. (2021). High-Dose Weekly Carfilzomib, Cyclophosphamide, and Dexamethasone in the Treatment of Patients with Relapsed and Refractory Multiple Myeloma–Exploring the Financial Cost and Rare Side-Effects (Doctoral dissertation, Queen's University (Canada)).

[7] Foundation, P. M. C. (2023, February 6). Paula and Rodger Riney Foundation donates $9.2-million CDN to princess margaret cancer centre to support Multiple Myeloma Research. Cision Canada. Retrieved February 8, 2023, from https://www.newswire.ca/news-releases/paula-and-rodger-riney-foundation….