Cost Saving with Home-Based Chemotherapy Approach in Multiple Myeloma The ADHOMY Trial

Author(s): Schulmann S, Achit H, Filliatre-Clément L, Di Santolo C, Ferry M, Vigneron J, Barbier-Lider P, Morice S, Campidelli A, Schirmer L, Keddar F, Ikhlef S, Moulin C, Augé H, Ziegler C, Feugier P, Saunier V, Guillemin F, Perrot A

Background: Bortezomib is a standard first-line therapy for multiple myeloma and also recommended in many associations for relapsing disease. When treatment is delivered in Outpatient Hospital (OH), patients should visit at least once a week for several months. Hospital-at-Home (HaH) is an attractive and suitable alternative to in-hospital treatment. The purpose of the study is to compare costs and patient-reported outcomes of two different strategies: exclusive OH-based bortezomib administration or combined administration in both OH and HaH.

Patients and Methods: A prospective non-randomized trial was conducted in Nancy University Hospital. The main objective was to compare patients’ quality of life (QoL) and costs incurred depending on two different ways of bortezomib administration: in OH only and in rotation between OH (the first cycle and every first day of each cycle) and HaH (the following days). QoL was measured using the EuroQol 5D (EQ-5D) and the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30 (QLQ-C30). The analysis was conducted from the National Health Insurance System (NHIS) perspective. Adverse events, unplanned hospitalizations, consultations and emergency unit visits were also collected.

Results: A total of 42 patients with a median age of 71 years (range 52-90) were enrolled in the study. The majority had IgG myeloma (52.4 %), 2 patients had t(4;14) and 1 patient had del(17p). Twenty patients received all bortezomib injections in OH (median of 24 injections) and 22 patients received bortezomib in OH alternately with HaH (median of 28.5 injections, 10.5 in OH and 18.0 in HaH respectively). The average cost per injection was 602.63 € in the OH group versus 479.52 € in the OH/HaH group. This represented a cost saving of 20.4% per injection to the NHIS in the combined strategy, with no difference in QoL.

Conclusion: Combined administration of bortezomib in OH and HaH was associated with a substantial cost-saving for NHIS and no difference in QoL at the end of treatment. This trial responds to French governmental and chronic patients’ wish to assess innovative ways of care and provide home treatment for as many patients as possible.

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