Psychiatric Comorbidities of Myeloma Lead to High Health-Care Costs

Many patients with multiple myeloma (MM) have a high risk for developing psychiatric comorbidities and, according to a study published in Blood Advances, managing these additional psychiatric conditions are associated with an increased use of health-care resources and higher health-care expense.

“An important component of survivorship is psychosocial well-being,” the study authors, led by Shehzad Niazi, MD, of the Mayo Clinic in Jacksonville, Florida, wrote. “Although novel therapeutic agents are considered the major cause of the increasing cost of cancer care, … caring for cancer patients with depression and other psychiatric conditions [has been] associated with significantly higher costs.”

The researchers reviewed the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database to collect information about two groups of patients who were diagnosed with MM between 1991 and 2010:

  • an “MM-only” group enrolled in and receiving Medicare benefits for one year before MM diagnosis (n=20,839)
  • an “MM + psychiatric” group with MM and a psychiatric diagnosis (n=15,168)

Because depression was the most common psychiatric condition in this dataset, the investigators also identified a separate group of 8,421 patients with MM and specifically depression (“MM + depression” group).

The median age for both the MM-only and MM + psychiatric groups was 76 years (range = 70-82 years). “There was a significant difference in sex distribution between the two groups,” the authors noted. “The majority (54.5%) of MM-only patients were males, whereas 51.1 percent of MM + psychiatric patients were females (p<0.001).”

Clinical myeloma-defining events (MDEs; defined as hypercalcemia, renal dysfunction, anemia, bone fractures, and dialysis >30 days post-diagnosis) were more frequent in the MM + psychiatric group (p<0.01 for all types). Compared with MM-only patients, the MM + psychiatric group had a significantly higher Charlson Comorbidity Index score at diagnosis (0 vs. 1, respectively; p<0.001).

In a comparison of the MM-only and MM + depression groups, the authors observed that women represented the majority (57.3%) of MM + depression patients (p<0.001).

Over a median follow-up period of 1.8 years (range not reported), health-care resource use (defined as the number of patients with MM receiving ambulatory, emergency department, or inpatient care) was higher in the MM + psychiatric and MM + depression groups, compared with the MM-only group. For example, 74% of patients in the MM-only group used inpatient care, while 81.6% of patients in the MM + psychiatric group reported used inpatient services (odds ratio = 1.48; 95% CI 1.39-1.57; p<0.001). See more results in TABLE 1.

Increased health-care resource use was coupled with increased health-care costs (defined as inpatient, outpatient, and drug charges from Medicare insurance claims within the first six months after MM diagnosis). The median costs of care were significantly higher among patients in the MM + psychiatric group, compared with MM-only individuals ($18,700 vs. $12,300; multivariate odds ratio [OR] = 1.25; 95% CI 1.20-1.31, p<0.001). Patients with MM and depression had an even higher cost of care compared with MM-only patients ($19,500 vs. $12,300; multivariate OR = 1.23; 95% CI 1.16-1.30; p<0.001).

Health-Care Resource Use by Setting

“Similar trends were noted when the cost of care for inpatient and outpatient care was evaluated separately, with the cost being highest for [the] MM + depression [group],” the authors reported (TABLE 2).

Health-Care Costs by Setting

According to the researchers, long-term systemic steroids may be a contributing factor to the higher risk of neuropsychiatric conditions for patients with MM, noting that “as many as three-fourths of those taking corticosteroids develop neuropsychiatric complications, likely increasing morbidity and cost of care.”

“Although national entities and accreditation bodies emphasize screening and identifying and addressing the psychological needs of cancer patients, more needs to be done,” the researchers concluded. They added that creating targeted treatment strategies for these patients must rely on the improved understanding “of the true prevalence of psychiatric comorbidities in cancer patients, as well as their impact on health-care [use] and cost of cancer care.”

The retrospective analysis of billing data for identifying psychiatric comorbidities in patients is a limitation of this study.

The researchers reported no financial conflicts.

Reference

Niazi S, Frank RD, Sharma M, et al. Impact of psychiatric comorbidities on health care utilization and cost of care in multiple myeloma. Blood Advances. 2018;2:1120-8.

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