The Future Of Myeloma! The Beginning Of The End?

What is the future of myeloma? I believe the future is much brighter!   We know myeloma patients who are found in stage 1 have a survival advantage twice that of a patient found in stage 3.  In addition, a patient who is found at 49 years of age or before has a survival advantage of  twice that of a patient found  when greater than 70 years old.  Finally, if found early at the time of high risk of progression smoldering myeloma, a clinical trial with treatment of Lenalidomide and dexamethasone showed only 5% of patients had died in the treatment group at 7 years, and 45% of the watch and wait group had died.  New trials are in the works (CESAR and ASCENT) designed to cure 50% of the high risk smoldering myeloma patients, and obviously if found before stage 1 will extend the life of those not cured.  One might also expect the devastating effects of CRAB (hypercalcemia, renal impairment, anemia, and bone pain and damage) conditions will be minimized.

So finding myeloma in its earliest stage is the key to improving overall survival, early treatment and myeloma cure!  And how is this done?  The answer may just be in the small country of Iceland.  A new clinical trial called iStopMM may be one of the most important events in modern day myeloma care. As part of the iStopMM study, all 140,000 Icelanders over the age of 40 will have their blood samples tested for the precursor to multiple myeloma, or MGUS (monoclonal gammopathy of undetermined significance), as well as find those who are smoldering or who are active but yet to be diagnosed.  Dr. Siguror Kristinsson of the University of Iceland discussed this exciting and groundbreaking study with us on September’s Myeloma Cure Talk and you can listen to the rebroadcast if you CLICK HERE.  Below Dr. Kristinsson explains the program, and how it fits into the International Myeloma Foundations new Black Swan Initiatives.  

The most important question to be answered is whether this is a viable and cost effective approach?  Can this program be scaled up to where it is not 140 thousand people tested, but 148.6 million people like it would be in the USA?    I say the answer is a resounding YES!   I truly hate the methodology of ICER where they determine the cost for one additional year of life of a patient.  ICER computes a year of life should not cost more than $50,000 to $100,000 per life year, and each myeloma patient’s year is only worth .7 years of that for a person without cancer.  All of the new drugs for myeloma like Kyprolis, Pomalyst, Elotuzumab, Ninlaro,and Daratumumab failed this test and had cost per year of life (QALY – quality adjusted life year) of  between $200,000 to $500,000.

I will not bore you with the detail (which is at the end of the post),  but my calculation would show this program will provide an ICER based cost per QALY of just $16,312 per QALY.  Or if I assume a myeloma patien’ts life has the same value as someone without cancer, the cost per QALY is $11,404.  So as you can see this project would be way below the ICER targeted cost per QALY.  However, because in the beginning all people over 40 would have to be tested in the first year, and thereafter just those who turn 40 need to be tested, I made this a 10 year project life.  After the 10th year the cost per QALY goes way down to just  $3521 per QALY.   So as you can see that even by ICER standards the cost per QALY is OUTSTANDING.  The numbers are big, but the payoff is huge as well.  If you want to go though the minutia of the analysis I have included it at the end of this post. 

Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

The analysis of cost

Data:

US population – 318.9 million
US population over 40 years of age – 46.6%
Percentage of the population who turns 40 each year – 1.25%
Cost for the light chain and M spike test per patient – $150
Number of myeloma cases each year – 30,330
Current life expectancy of a myeloma patient – 5 years
Average age of a myeloma patient – 69 years
Average life expectancy of an American at age 69 -16 years
If treated early 50% of patients are believed to be cured or live an additional 11 years
If treated early the other 50% will live twice the current average or 5 additional years

10 year project cost

First year cost – 318,900 x .466 x $250                  =    $22,291,050,000
Year 2 thu 10     318,000 x .125 x $250 x 9            =        $ 598,000,000
Total 10 year cost                                                          $27,673,000,000

Life years saved

Cure (30,330 x .5 x 11 x10years)                               =           1,668,150
Double life to 10 years (30,330 x.5 x 5 x 10)              =              758,250
Total 10 life years saved                                                           2,426,400

QALY’s   (2,426,400 x .7)                                                          1,696,480

Cost per QALY  ($27,673,000,000/1,696,480)             =            $16,312    
Cost per Life Year ($27.673,000,000/2,426,400)         =            $11,404