Therapeutic Options in the Treatment of Multiple MyelomaPharmacoeconomic and Quality-of-Life Considerations

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 $US10 000 (1995 values). As median survival is prolonged from less than a year in untreated patients to 30 to 36 months, this treatment must be considered cost effective. Interferon-a has a modest effect on progression-free and overall survival when added to chemotherapy regimens.However, the high cost and toxicity of this drug results in an unfavourable cost-utility ratio, estimated to be between $US50 000 to $US100 000 per quality-adjusted life-year gained.