Guideline Recommended Testing For Early Myeloma Improves Outcomes, Reduces Costs

Researchers at the ASH 2017 Annual Meeting and Exposition found that performing National Comprehensive Cancer Network (NCCN) guideline recommended to detect early signs of myeloma reduces hospital costs.

Elizabeth Wu, MPH, health economist at Precision Health Economics, and colleagues explained that multiple myeloma is a cancer of the plasma cells with a presentation that often makes diagnosis difficult.

“The early symptoms of multiple myeloma are often vague and non-specific, such as fatigue, bone pain, and back pain,” they wrote in their presentation. “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 multiple myeloma diagnosis (163 days) is longer than for most other hematologic cancers including leukemias and lymphomas.”

They further explained that this delayed diagnosis leads to complication, added costs, and worse outcomes. 

“Delayed diagnosis of multiple myeloma is commonly associated with the development of chronic complications such as renal impairment, infections, neurological disease, bone disease, and anemia,” Dr Wu and colleagues said. “Therefore, early detection and diagnosis of multiple myeloma are essential to avoid downstream complications, and may significantly reduce the treatment costs associated with these complications.”

According to the presentations, NCCN guidelines recommend use of three test to maximize early diagnosis of multiple myeloma, including serum protein electrophoresis, serum immunofixation electrophoresis, and serum free light chains. They noted that despite these recommendation, primary care providers still have a hard time diagnosing multiple myeloma. 

“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,” they said.

In order to test the practicality and efficacy of the NCCN guidelines, the researchers studied a modeled hospital that complied with the testing recommendations.

The researchers found that the average integrated delivery network in their model had 967 patients undergoing multiple myeloma testing annually. Study results showed that converting to NCCN guideline compliance reduced the time to diagnosis from 159 days to 45 days per patient.

Cost implication of guideline implementation translated to an additional $37,680 in diagnostic testing costs per year; however, hospitals saved $74,135 annually in averted complications.

“Guideline recommended testing of patients with early symptoms of multiple myeloma can help reduce costs, improve patient outcomes, and increase efficiency of care,” Dr Wu and colleagues concluded. “Hematologists, as stewards
of the guidelines, should help in educating primary care physicians on warning signs of multiple myeloma and appropriate diagnostic tests.”

—David Costill