Comparative modeling of multiple myeloma across myeloma control continuum: prevention, treatment, and disparity reduction

PROJECT SUMMARY/ABSTRACT This application is being submitted in response to the Notice of Special Interest identified as NOT-CA-23-044. Multiple myeloma (MM) is a common and lethal hematologic malignancy. With the recent development of novel MM treatments, median survival has significantly improved; however, the long-established racial disparities in

MM continue to exist. This may be attributable to the high cost of these treatments and inequitable access to care, which was further exacerbated by the recent inflation surge since 2021. The inflation has negatively impacted patients with MM, as the management of MM is the most costly among all cancer sites. To curb this

inflation and reduce the financial burden of Medicare enrollees, the Inflation Reduction Act (IRA) was signed into law in 2022. Among several provisions, the cap placed on patient out-of-pocket (OOP) spending of $2,000 starting in 2025 for Medicare Part D enrollees is expected to significantly reduce the skyrocketing high OOP

cost, potentially increase accessibility of novel treatments, and mitigate disparities for patients diagnosed with MM. However, to what extent these impacts remains unknown. To assess these impacts, we propose to investigate the relationship between OOP costs and treatment utilization pattern among Medicare Part D

enrollees with MM (Aim 1). Furthermore, we will predict the impact of the IRA OOP cap on Part D enrollees with MM, including the impacted size of patient population, novel treatment utilization, patient survival, lifetime healthcare cost, and racial disparities in MM survival (Aim 2). The proposed supplement will utilize the established infrastructure of NCI-funded CISNET Multiple Myeloma

Incubator Program (U01CA265735), including 1) CISNET-standard, evidence-based, calibrated models of natural history of MM from Washington University and Yale University modeling groups; and 2) the coordination of the Coordinating Center for comparative modeling to ensure robust and credible conclusions

with transparent model assumptions, design, and parameterization, as well as high-quality reporting of the findings. This supplement will expand the two models designed to evaluate the cost-effectiveness of novel treatments to ones with the capability to evaluate external economic shocks and the corresponding economic

policies. The expanded models will significantly strengthen the public health impact of the parent grant. This supplement is significant in its capability to 1) predict and quantify the impacts of the recent inflation surge and the IRA OOP cap in patients diagnosed with MM to better our understanding about the potential

impacts on novel treatment utilization, MM survival, and MM health disparities; and 2) expand the models for natural history of MM to allow for the assessment of external shocks. It is also innovative in its approach used to answer the research question, including state-of-the-art, evidence-based simulation models for MM and

comparative modeling to ensure robust conclusions. Successful completion of this study will provide evidence in tangible metrics to assess the impacts of the recent inflation surge and the IRA OOP cap in MM patients.