Higher Health Care Burden in Multiple Myeloma With Extramedullary Disease, Study Finds
Key Clinical Summary
- Triple-class–exposed (TCE) relapsed/refractory multiple myeloma (RRMM) patients with extramedullary disease (EMD) had higher hospitalization rates, longer stays, and greater health care costs than those without EMD.
- Mean all-cause monthly costs were $41 428 for EMD vs $34 508 for non-EMD, driven largely by inpatient, outpatient, and pharmacy expenditures.
- Costs escalated further following disease progression, underscoring unmet treatment needs.
New real-world findings presented at the 22nd International Myeloma Society Annual Meeting reveal significantly higher health care resource utilization (HRU) and economic burden among US patients with TCE RRMM who also have EMD. The analysis, conducted using Komodo’s Healthcare Map, compared HRU and costs between TCE patients with and without EMD.
Study Findings
The retrospective observational study included 310 patients with EMD and 5301 without EMD who initiated a subsequent line of therapy between January 2020 and August 2023. The median age was 62 years (EMD) and 65 years (non-EMD), with similar distributions across sex and race. Median follow-up was 10.0 and 12.7 months, respectively.
Hospitalization patterns differed notably between the 2 groups. Patients with EMD had a higher hospitalization rate, with 64.8% experiencing at least 1 hospital stay compared with 60.0% of those without EMD. They were also hospitalized more frequently, averaging 0.23 hospitalizations per patient per month (PPPM) vs 0.16 in the non-EMD cohort. In addition, the average length of stay was longer among patients with EMD, reaching 2.2 days PPPM compared with 1.6 days PPPM for those without EMD.
Cost analyses showed substantial disparities. Mean all-cause costs (2024 USD, PPPM) were $41 428 for patients with EMD and $34 508 for patients without EMD.
Spending was primarily driven by inpatient costs ($13 082 vs $7947), outpatient services ($15 560 vs $14 668), and pharmacy claims ($12 116 vs $11 496). Similarly, mean MM-related monthly costs were higher in the EMD group: $39 658 vs $32 848.
Among the 121 EMD patients who advanced to a subsequent line of therapy, financial burden intensified. Mean all-cause costs rose from $43 154 during the index therapy to $53 207 afterward; MM-related costs increased from $41 189 to $52 476. These increases illustrate the accelerating burden of disease progression.
Clinical Implications
For payers and managed care leaders, these findings highlight the profound clinical and economic complexity of treating TCE RRMM, particularly in patients with EMD. Elevated HRU—including higher rates of hospitalization, longer inpatient stays, and heavier outpatient utilization—translates into substantial cost pressures across care settings.
The data also reinforce the lack of effective therapeutic options for this high-risk population. Although emerging therapies such as GPRC5D- and BCMA-targeted agents (eg, talquetamab and teclistamab) have shown promise in clinical trials, real-world outcomes remain challenging. The sharp cost increases following disease progression further emphasize the need for timely access to innovative treatments, supportive care optimization, and strategies to reduce inpatient dependency.
For health plans, identifying EMD early and assessing risk for intensive resource use may aid in proactive care planning, budgeting, and pathway design.
Conclusion
This US real-world study demonstrates that EMD significantly amplifies the clinical and economic burden among patients with TCE RRMM. As new therapeutic options emerge, continued research and payer-provider collaboration will be essential to improve outcomes while mitigating escalating costs.
Reference
Lee HC, Harper JS, Le HH, et al. Real-world healthcare resource utilization and costs among triple-class–exposed relapsed/refractory multiple myeloma patients with and without extramedullary disease in the United States. Presented at: 22nd International Myeloma Society (IMS) Annual Meeting; September 17-20, 2025; Toronto, ON, Canada.
