An Economic Model to Establish the Costs Associated With Routes to Presentation for Patients With Multiple Myeloma in the UK

Objectives: Patients with myeloma often face significant diagnostic delay, with up to one-third of UK patients diagnosed after an emergency presentation (EP). Compared with other 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 lifetime time horizon to estimate costs related to different presentation routes (EP, general practitioner [GP] 2-week wait, GP urgent, GP routine, and consultant to consultant) for UK patients diagnosed as having myeloma. After diagnosis, patients received one of 3 first-line management options (observation, active treatment, or end-of-life care). Inputs were derived from UK health technology assessments and targeted literature reviews, or based on authors' clinical experience where data were unavailable. Active treatment, complication, and end-of-life care costs were included.Results: The average per-patient cost of treating myeloma (across all routes) was estimated at 146 pound 261. The average per -patient cost associated with EP (152 pound 677) was the highest; differences were minimal compared with GP 2-week wait (149631) pound and consultant to consultant (147 pound 237). GP urgent (140025) pound and GP routine (130212) pound were associated with marginally lower costs. Complication (42252) pound and end-of-life care (11273) pound costs were numerically higher for EP than other routes (25 pound 021-38 pound 170 and 9772- pound 10 pound 458, respectively).Conclusions: An economic benefit may be associated with earlier diagnosis, gained via reduced complication and end-of-life care costs. Strategies to expedite myeloma diagnosis and minimize EPs have the potential to improve patient outcomes and may result in long-term savings that could offset any upfront costs associated with their implementation.

Automated summary

Patients with myeloma often face significant delays in diagnosis, especially those who are diagnosed after an emergency presentation. Emergency patients have more advanced disease and poorer prognosis compared to other routes. Early diagnosis may result in economic benefits by reducing complication and end-of-life care costs and improving patient outcomes.