LAUSR

BACKGROUND In 2017, lenalidomide maintenance therapy (R-MT) was approved for patients (pts) who received an up-front autologous hematopoietic stem cell transplantation (ASCT) in the United States (US) and Europe. The total cost of care for pts on R-MT in the US has not been previously studied using a large administrative claims database. This study aimed to compare real-world outcomes and costs among pts with newly diagnosed multiple myeloma (MM) receiving R-MT vs no maintenance (No-MT) post ASCT. METHODS From the Truven Marketscan data set, we identified adult pts with ≥ 2 claims for MM (International Classification of Diseases, 9th/10th Revision, Clinical Modification code: 203.0x, C90.0x) 30 days apart and ≥ 1 MM treatment during the identification period (1/1/2011 to 9/30/2016). Pts were required to have continuous enrollment for 6 months pre and ≥ 6 months post initial ASCT date plus 90 days (index date), in addition to ≥ 1 full cycle of therapy with a valid first-line regimen, and evidence of ASCT during follow-up period. Patients were excluded if they had evidence of prior MM diagnosis or treatment. R-MT was defined as lenalidomide monotherapy of RESULTS A total of 250 and 233 pts initiated R-MT and No-MT, respectively. Mean age (58.5 vs 58.0 y, P= .5236) and Charlson Comorbidity Index score (5.2 vs 5.3, P= .5234) were similar, but there were more males in the No-MT group (52.0% vs 61.4%, P= .0378). Time from start of first-line regimen to ASCT (5.48 vs 5.47 months, P= .9589) and the mean follow-up time post index date (22.1 vs 21 months, P= .1414) were similar in both groups. R-MT pts had a median duration of maintenance of 10 months. The median TTTD using the KM method was 21.02 months (95% CI: 16.78, 25.76). During the study period, a total of 60 (24%) and 99 (42.5%) R-MT and No-MT pts received a second-line treatment. At 12, 24, and 36 months, the proportion of pts who had a second-line treatment was as follows: R-MT-12.4%, 21.2%, 22.8%; No-MT-35.2%, 40.3%, 42.1%. Median TTNT was significantly longer among those treated with R-MT vs No-MT (Figure 1). Adjusted total PPPM costs during the first 12 months of follow-up was higher among pts treated with R-MT vs No-MT ($13,095 vs $8,910, adjusted difference $4,514, P CONCLUSION Pts remain on R-MT for several months to well over a year. R-MT pts incurred higher costs within the study period; however, their TTNT was significantly longer, and they were over half as likely to progress to a second-line treatment compared with No-MT pts. Pharmacy costs in R-MT pts were higher in the initial year of follow-up while No-MT pts had higher outpatient costs, presumably driven by the need for second-line therapy in a higher proportion of patients. Additional follow-up is required to assess total healthcare costs in subsequent years. Disclosures Hari: Celgene: Consultancy, Honoraria, Research Funding. Ung: Celgene Corporation: Other: Fellowship is funded by Celgene. Abouzaid: Celgene Corporation: Employment, Equity Ownership, Research Funding. Ni: Celgene: Employment. Parikh: Celgene Corporation: Employment. Agarwal: Celgene Corporation: Employment.