摘要:
Introduction : Multiple myeloma (MM) is a hematologic cancer of the plasma cells, which are found in the bone marrow. The early symptoms of MM are often vague and non-specific, such as fatigue, bone pain and back pain. These vague symptoms lead patients to present first to their primary care physician and often delay diagnosis resulting in progressive disease [***]. The median time for MM diagnosis (163 days) is longer than for most other hematologic cancers including leukemias and lymphomas [Howell et al, BMC Hematol, 2013]. Delayed diagnosis of MM is commonly associated with the development of chronic complications such as renal impairment, infections, neurological disease, bone disease and anemia [Kariyawasan et al, Q J Med, 2007]. Therefore, early detection and diagnosis of MM are essential to avoid downstream complications, and may significantly reduce the treatment costs associated with these complications. In the assessment of symptomatic patients, National Comprehensive Cancer Network (NCCN) practice guidelines recommend using three tests to maximize sensitivity and specificity: serum protein electrophoresis (SPE), serum immunofixation electrophoresis (SIFE) and serum free light chains (SFLC) [NCCN Multiple Myeloma Guidelines Version 3.2017]. However, physician compliance with these guidelines is hampered by the many different test options available and the low visibility of Myeloma on the list of possible causes for the primary care physician. In the current study, we modeled the effect of converting a hospital system over to guideline compliance in testing for Multiple Myeloma. Methods : A decision analytic model was developed to estimate the total costs and annual budget impact when using the guideline recommended panel for early diagnosis of MM patients. Using a US hospital (i.e., integrated delivery network [IDN]) model perspective, a decision algorithm was developed based on NCCN and IMWG clinical practice guidelines and further validated by