Electronic Theses and Dissertations

Date of Award

1-1-2020

Document Type

Dissertation

Degree Name

Ph.D. in Pharmaceutical Sciences

First Advisor

Yi Yang

Second Advisor

Ruchit Shah

Third Advisor

Sujith Ramachandran

School

University of Mississippi

Relational Format

dissertation/thesis

Abstract

This dissertation aimed at filling the gaps in the body of multiple myeloma (MM) literature by comparing overall survival and safety of first line maintenance or continuous treatment, and assessing disease lifetime costs, phase-specific costs and its drivers among elderly newly diagnosed (NDMM) patients. Moreover, it aimed to assess trends in EOL care and the impact of PCC on EOL care outcomes among elderly MM patients. First, this study assessed the comparative safety and effectiveness among those who received first line LEN-based treatment versus those who received first line BORT-based treatment. The results from the study demonstrates an overall survival benefit and similar toxicity risk for patients receiving first line LEN-based continuous or maintenance treatment over those who received first line BORT-based treatment. Further, the study results highlighted the substantial economic burden associated with MM care, in spite of the disease having low prevalence as compared to some of the other cancers. The incremental phase-specific costs were highest for the initial care phase, followed by the terminal phase, with costs being slightly lower for the continuing care phase, and lowest for the pre-diagnosis phase. Inpatient and outpatient costs were the major drivers of costs in all the four phases. Pharmacy costs were a significant driver of costs in the initial and terminal phases, and were the biggest cost driver in the continuing care phase. Last, it assessed trends in aggressiveness of EOL care outcomes over time. While certain indicators of aggressive EOL care remained stable over time, we observed an increasing trend for multiple ED visits and ICU stays. Moreover, this study assessed the impact of palliative care consultations on receiving aggressive EOL care, and healthcare resource use and costs at EOL. Results indicate that early palliative care consultations have the potential to reduce aggressive EOL care, and curtail healthcare resource use and costs at EOL. Study findings about clinical and economic outcomes will help inform clinicians’ treatment decisions, aid policy discussions regarding MM care and coverage, and help design interventions to integrate early palliative care into routine care among elderly MM patients.

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