Older Patients With Myeloma Face High Costs After Skeletal-Related Events

A study published in the Journal of Bone Oncology quantified post-discharge healthcare costs for older patients with multiple myeloma (MM) after hospitalization for skeletal-related events (SRE).

Patients with MM are at increased risk of SREs due to bone lesions associated with this condition. According to the study authors, previous research on direct inpatient costs of SREs has been conducted, but there is a lack of data on costs associated with post-SRE care.

To examine this, the investigators utilized Medicare data to identify 4,277 patients with MM discharged from SRE-related hospitalizations between 2011 and 2015. The mean patient age was 76.6 years.

The team evaluated costs spanning from time of discharge to the earliest of either death, end of Medicare enrollment, or the data cutoff of December 31, 2015. Patients were stratified according to discharge status, including skilled nursing facility, rehabilitation facility, hospice, home health agency, long-term care (LTC) nursing home or hospital, or rehospitalization within or after 30 days. The investigators calculated stay duration and costs accrued for each setting.

The most frequent discharge status among patients with MM following SREs was to skilled nursing facilities, at 35.9% of patients. Home health agencies were the second most common discharge status (18.2%), followed by hospice (7.2%). Discharge to LTC nursing home or hospital was the least common, at 1.5% of patients. Nearly 10% of patients were re-hospitalized within 30 days.

The range of mean Medicare cost accrued per facility was between $15,517 per patient in LTC nursing home care to $49,729 per patient in an LTC hospital setting. Hospice was the cheapest option, at a mean cost of less than $10,000 per patient.

“Compared with the general Medicare population, in the study samples, percentages of admissions to institutional post-acute care facilities such as skilled nursing facilities, rehabilitation facilities, or LTC facilities were higher, stays in those facilities were longer, and resulting total Medicare costs were higher,” wrote the study authors in conclusion. “Post-discharge management after SRE hospitalization is clinically and economically significant for elderly patients, has significant implications for public health, and highlights the need for primary prevention of these painful and costly events.”