Analysis of medicines to treat multiple myeloma
Page last updated: 2 March 2018
Drug utilisation sub-committee (DUSC)
September 2017
Abstract
Purpose
At its June 2017 meeting, DUSC requested a review of medicines to treat multiple myeloma supplied through the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS). A predicted versus actual analysis for pomalidomide was also undertaken.
Date of listing on the Pharmaceutical Benefits Scheme (PBS)
|
Drug |
Abridged restriction |
Date |
|---|---|---|
|
Thalidomide |
Relapsed or refractory multiple myeloma. |
1 February 2006 |
|
Bortezomib |
As monotherapy or in combination with a corticosteroid for multiple myeloma after at least 1 prior therapy (except thalidomide). |
1 November 2007 |
|
Thalidomide |
Multiple myeloma. |
1 September 2009 |
|
Lenalidomide |
As monotherapy or in combination with dexamethasone for multiple myeloma after at least 1 prior therapy. |
1 November 2009 |
|
Bortezomib |
Newly diagnosed patients with symptomatic multiple myeloma. |
1 October 2012 |
|
Pomalidomide |
In combination with dexamethasone for multiple myeloma after prior treatment failure with bortezomib and treatment failure with lenalidomide. |
1 August 2015 |
|
Lenalidomide |
In combination with dexamethasone for newly diagnosed patients with multiple myeloma. |
1 February 2017 |
See the PBS website for full details of the restrictions.
Data Source / Methodology
The prescription dispensing data were extracted from the Department of Human Services (DHS) prescription database. This contained non-identifying patient level PBS & RPBS (R/PBS) data for the time period 1 July 2013 to 31 December 2016. The medicines to treat multiple myeloma (MM) that were included in the analysis were thalidomide, bortezomib, lenalidomide and pomalidomide.
Data extracted from DHS was used to determine the date of death of patients. Data was supplied for patients who died in the time period 1 July 2013 and 31 December 2016.
R/PBS data were used to determine:
- the prevalent and incident populations treated with the PBS listed medicines for multiple myeloma
- clinical pathways of use of medicines for multiple myeloma, including first, second and third line treatment.
- the duration of treatment with medicines for multiple myeloma
- the extent of co-prescribing of two or more medicines for multiple myeloma.
- the consistency of use of PBS subsidised medicines for multiple myeloma with the recommendations in Australian guidelines (1) and the PBS restrictions.
Key Findings
- Overall, 9,445 people received 204,947 dispensings for the medicines listed for multiple myeloma in the period 1 July 2013 to 31 December 2016. The number of people receiving treatment rose from 9.4 per 100,000 in July 2013 to 11.8 per 100,000 in December 2016.
- 1,826 people initiated therapy with the medicines listed for multiple myeloma in 2016, with most initiating bortezomib. Their median age was 70 years. This is consistent with AIHW (2013) estimates of incidence of approximately 1,600 persons per year.
- 61% of people treated for multiple myeloma received one therapy only in the period 2014-2016, with two-thirds of these receiving therapy with bortezomib only, a quarter receiving thalidomide only, and the remaining receiving therapy with lenalidomide only. Where people did require a second therapy, the most common pathways were from bortezomib to thalidomide, and thalidomide to lenalidomide.
- For patients eligible for stem cell transplant who initiated therapy in 2014, the median duration of the first episode on bortezomib was 3 months; it was 3.5 months for other bortezomib; it was 5 months for thalidomide and 9.5 months for lenalidomide.
- Analysis on cumulative duration of all episodes on any medicine showed a median duration of 282 days (95% CI 269-293). Analysis on cumulative duration of all breaks (gaps) in medicine coverage showed a median duration of 29 days (95% CI 21-39). The majority of the people survived the two year follow-up (Figure 9); overall 11% died within the follow-up period.
- There was very little co-prescribing. Only 1% of all 9,445 people with a multiple myeloma medicine between 1 July 2013 and 31 December 2016 had concurrent use of two medicines listed for multiple myeloma for a whole month at some point of time.
- Utilisation was mostly consistent with guideline recommendations and PBS restrictions. The use found outside the recommendations was for pomalidomide which was first or second line therapy in 1% of people, and for lenalidomide as first line therapy. The analysis showed that lenalidomide accounted for 6% of first line medicine use when assessed across the 2014 to 2016 cohort, and up to 12% when assessed in the 2014 cohort alone.
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