An economic model to establish the costs associated with routes of presentation for patients with Myeloma in the UK

Background Patients with myeloma often face significant diagnostic delay, with over a quarter of patients in the UK diagnosed following emergency presentation (EP) [1]. Compared with other presentation routes, patients presenting as an emergency have more advanced disease, increased complications and poorer prognosis. Methods An economic model was developed using a decision-tree framework and a lifetime time horizon to estimate costs related to presentation routes (EP, general practitioner [GP] suspected cancer referral with a maximum two-week wait [TWW], GP urgent, GP routine and consultant-to-consultant, categorised by Howell et al [2017] [1]) for patients diagnosed with myeloma in the UK. Following diagnosis, patients received one of three first-line management options (observation, active treatment with anti-myeloma drugs, or end-of-life [EOL] care). Those receiving observation were assumed to have a diagnosis of smouldering myeloma but could progress to active myeloma and receive active treatment. Inputs were derived from UK health technology assessments, targeted literature reviews, or based on authors’ clinical experience where data were unavailable. Active treatment (drug acquisition, administration, adverse event and monitoring for several treatment lines), complication and EOL care costs were included. The model took a UK National Health Service and personal social service perspective. Results The average, undiscounted, per patient cost of treating myeloma (across all routes) was estimated at £168,000. The average per patient cost associated with EP (£174,987) was higher than for other routes (£151,370–£170,371). Complication and EOL care costs were higher for EP (£56,091) than other routes (£36,987–£49,844). Active treatment at diagnosis comprised 94% of total treatment costs for EP, versus 64–78% for other routes. For EP, 5% of total treatment costs were attributed to patients who received initial observation, but progressed to active disease and received treatment, whilst for other routes this ranged from 20–35%. In the absence of data, active treatment was modelled identically for patients receiving active treatment at diagnosis or after initial observation, thus total treatment costs were similar across routes. Should initial observation impact subsequent active treatment (e.g. duration of treatment-free intervals), total treatment costs may differ between EP and other routes. Conclusions An economic benefit may be associated with earlier diagnosis, gained via reduced complication and EOL care costs, with a difference of £19,104 per patient observed between EP and the GP routine route. The impact of initial observation on subsequent active treatment remains a key data gap. Acknowledgements This research was conducted free-of-charge on a pro bono basis by Costello Medical.