Contributions
Abstract: PB1742
Type: Publication Only
Session title: Quality of life, palliative care, ethics and health economics
Background
Multiple myeloma (MM) is the second most frequent hematologic malignancy. In the past few years, the approval of new drugs has significantly modified the management of this disease allowing outpatient care either in hospital-at-home or in outpatient hospital settings. However, little is known about the real-world management of MM patients in France and the factors influencing patients’ orientation and use of the different hospital care facilities available.
Aims
To describe the real-world management of MM patients treated as outpatients with injectable chemotherapy. To assess determinants of being treated in each setting including patients related features and organization related features.
Methods
Methods: We conducted an observational, retrospective, cross-sectional study using the exhaustive national French hospital discharge database (PMSI). All myeloma patients with MM diagnosis (ICD-10 code=C90.0) having received at least one chemotherapy injection either in hospital at home or in outpatient hospital, in a hospital center offering both modalities of care, were included. The primary outcome was the proportion of patients having received at least one chemotherapy injection in the hospital at home setting in 2018. The following variables were collected: patient’s age and gender, Charlson comorbidity index, time from MM diagnosis, distance from home to the hospital, number of inhabitants and median pre-tax annual income of the patient’s city of residence, name of the chemotherapy when data available. To quantify the respective influence of each factor on access to hospital at home facilities, a logistic regression model was run on a 90% training set and assessed on a 10% test set.
Results
In 2018, 12,493 MM patients received at least one chemotherapy injection in France. 623 were excluded because of missing data and 8,245 because they had not been treated in center offering hospital at home chemotherapy. In total, 3,625 MM outpatients from 21 centers were included, of whom 1,180 (32.6%) had at least one chemotherapy injection delivered in the hospital at home setting. On average, those patients were 68 years (SD 11.3) old. Charlson comorbidity index was 5.5 (SD
2.6). Patients lived 26 kilometers (SD 29) away from the hospital. Time from MM diagnosis was 20.6 months (SD 14.9). The average size of the city of residence was 51,283 inhabitants (SD 67,097) and the median annual income was 22,702 Euros (SD 5,007). These patients were treated in 21 different centers, among which 9 teaching hospitals; 2,192 patients (60.5%) received bortezomib and 253 (7%) received carfilzomib.
After adjustment, the probability of having received at least one chemotherapy injection in the hospital at home setting was significantly higher for patients treated by bortezomib versus not treated by bortezomib (OR=21.3; 95IC=16.4-28.2) and living in more affluent cities (OR=1.07; 95IC=1.05-1.09). This probability was significantly lower for patients living further from the hospital (OR=0.99; 95IC=0.98-1.00) and in larger cities (OR=0.98; 95IC=0.97-0.98). The overall model fit was good (area under the ROC curve=0.83).
Conclusion
In this observational, retrospective, nationwide, real-world study in France, MM patients getting access to injectable chemotherapy in hospital at home facilities are more frequently treated by bortezomib and live closer to the hospital, in smaller and richer cities. These results suggest that organizational interventions could help reducing the observed disparities in access to hospital at home facilities.
Keyword(s): Myeloma
Abstract: PB1742
Type: Publication Only
Session title: Quality of life, palliative care, ethics and health economics
Background
Multiple myeloma (MM) is the second most frequent hematologic malignancy. In the past few years, the approval of new drugs has significantly modified the management of this disease allowing outpatient care either in hospital-at-home or in outpatient hospital settings. However, little is known about the real-world management of MM patients in France and the factors influencing patients’ orientation and use of the different hospital care facilities available.
Aims
To describe the real-world management of MM patients treated as outpatients with injectable chemotherapy. To assess determinants of being treated in each setting including patients related features and organization related features.
Methods
Methods: We conducted an observational, retrospective, cross-sectional study using the exhaustive national French hospital discharge database (PMSI). All myeloma patients with MM diagnosis (ICD-10 code=C90.0) having received at least one chemotherapy injection either in hospital at home or in outpatient hospital, in a hospital center offering both modalities of care, were included. The primary outcome was the proportion of patients having received at least one chemotherapy injection in the hospital at home setting in 2018. The following variables were collected: patient’s age and gender, Charlson comorbidity index, time from MM diagnosis, distance from home to the hospital, number of inhabitants and median pre-tax annual income of the patient’s city of residence, name of the chemotherapy when data available. To quantify the respective influence of each factor on access to hospital at home facilities, a logistic regression model was run on a 90% training set and assessed on a 10% test set.
Results
In 2018, 12,493 MM patients received at least one chemotherapy injection in France. 623 were excluded because of missing data and 8,245 because they had not been treated in center offering hospital at home chemotherapy. In total, 3,625 MM outpatients from 21 centers were included, of whom 1,180 (32.6%) had at least one chemotherapy injection delivered in the hospital at home setting. On average, those patients were 68 years (SD 11.3) old. Charlson comorbidity index was 5.5 (SD
2.6). Patients lived 26 kilometers (SD 29) away from the hospital. Time from MM diagnosis was 20.6 months (SD 14.9). The average size of the city of residence was 51,283 inhabitants (SD 67,097) and the median annual income was 22,702 Euros (SD 5,007). These patients were treated in 21 different centers, among which 9 teaching hospitals; 2,192 patients (60.5%) received bortezomib and 253 (7%) received carfilzomib.
After adjustment, the probability of having received at least one chemotherapy injection in the hospital at home setting was significantly higher for patients treated by bortezomib versus not treated by bortezomib (OR=21.3; 95IC=16.4-28.2) and living in more affluent cities (OR=1.07; 95IC=1.05-1.09). This probability was significantly lower for patients living further from the hospital (OR=0.99; 95IC=0.98-1.00) and in larger cities (OR=0.98; 95IC=0.97-0.98). The overall model fit was good (area under the ROC curve=0.83).
Conclusion
In this observational, retrospective, nationwide, real-world study in France, MM patients getting access to injectable chemotherapy in hospital at home facilities are more frequently treated by bortezomib and live closer to the hospital, in smaller and richer cities. These results suggest that organizational interventions could help reducing the observed disparities in access to hospital at home facilities.
Keyword(s): Myeloma