CLINICAL NEWS multiple myeloma ( MM ), [ which ] suggests that the LIS may have facilitated access to IMiDs .”
Out-of-pocket expenses ( determined by a review of health-care records and Medicare Part B data ) also differed dramatically : Patients receiving LIS paid $ 3 out-of-pocket for their first IMiD prescription ( including thalidomide and lenalidomide ), compared with $ 3,178 for those who did not receive LIS .
The researchers used the Surveillance , Epidemiology , and End Results ( SEER )– Medicare database to identify patients diagnosed with MM between 2007 and 2011 . Patients were included in the analysis if they were continuously enrolled in Medicare Parts A and B from 12 months prior to diagnosis and onward , were not participating in a managedcare plan , and had Medicare Part D coverage at diagnosis . Patients who had prescription coverage provided by other sources or no creditable coverage were excluded .
Of the 3,038 beneficiaries included , 2,059 received LIS ( median age = 76 years ; range = 71-81 years ) and 979 did not ( median age = 76 years ; range = 71-82 years ). All patients initiated chemotherapy a median of 1.1 months ( range = 0.7-1.9 months ) after MM diagnosis .
A total of 1,250 patients ( 41.1 %) received an IMiD as part of firstline therapy ( defined as drugs administered during the first 60 days of treatment ): 42 percent in the LIS group and 41 percent in the non-LIS group . Univariate analysis determined that patients receiving IMiDs were more likely to be younger , have better performance status , and have fewer comorbidities .
On average , patients received six IMiD prescriptions during the first year of treatment ( range = 3-11 prescriptions ), at a median gross drug cost of $ 39,250 ( range = $ 15,145- 70,133 ). The gross drug cost for the first prescription alone was $ 6,927 ( range = $ 4,125-7,522 ). The median duration of firstline therapy was 7.6 months ( range not provided ), with 38 percent of patients continuing treatment for more than 12 months .
“ We found that for Part D beneficiaries without LIS , the use of IMiDs entailed median out-of-pocket expenses of [ more than ] $ 5,600 in the first year , corresponding to 23 percent of their median yearly income ($ 24,150 in 2014 ),” the authors wrote . Median patient cost-sharing for those with and without LIS were :
• First prescription : $ 3 ( range = $ 3-6 ) and $ 3,178 ( range = $ 2,079-4,018 )
• First year of therapy : $ 6 ( range = $ 3-10 ) and $ 5,623 ( interquartile range = $ 3,882- 9,437 )
Patients receiving LIS had significantly more comorbidities , worse performance status , and less favorable socioeconomic characteristics . Older patients ( 75-84 years ) receiving LIS had a 32 percent higher probability of being treated with an IMiD , compared with non-recipients ( 95 % CI 16-47 ; p < 0.001 ).
Receipt of LIS also appeared to lower the likelihood of prolonged (> 45 days ) delays between IMiD prescriptions ( relative risk = 0.54 ; 95 % CI 0.32-0.92 ; p value not reported ), regardless of patient age , but not the duration of IMiD therapy ( hazard ratio = 1.02 ; 95 % CI
0.87-1.20 ; p value not reported ).
When the authors compared health-care resource use between patients in the SEER cohort treated with IMiDs and a reference group of patients treated with bortezomib , they found that IMiD use was associated with a significantly lower incidence of visits to the emergency department , regardless of whether patients received LIS ( p = 0.012 for LIS non-recipients and p = 0.004 for LIS recipients ), but not for patients treated with bortezomib ( p = 0.17 and p = 0.72 , respectively ). The same was true for the frequency of hospitalizations among IMiD-treated
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References : 1 . Franchini M , Mannucci PM . The history of hemophilia . Semin Thromb Hemost . 2014 ; 40:571-576 . 2 . Peyvandi F , Garagiola I , Young G . The past and future of haemophilia : diagnosis , treatments , and its complications . Lancet . 2016 ; 388:187-197 . 3 . Lenting PJ , van Mourik JA , Mertens K . The life cycle of coagulation factor VIII in view of its structure and function . Blood . 1998 ; 92 ( 11 ): 3983-3996 . 4 . Antovic A , Mikovic D , Elezovic I , Zabczyk M , Hutenby K , Antovic JP . Improvement of fibrin clot structure after factor VIII injection in haemophilia A patients treated on demand . Thromb Haemost . 2013 ; 111 ( 4 ): 656-661 . 5 . Hvas AM , Sørensen HT , Norengaard L , Christiansen K , Ingerslev J , Sørensen B . Tranexamic acid combined with recombinant factor VIII increases clot resistance to accelerated fibrinolysis in severe hemophilia A . J Thromb Haemost . 2007 ; 5:2408-2414 .
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