Private Institutions Linked with Better Multiple Myeloma Survival in Brazil

Better survival outcomes were observed among patients with multiple myeloma (MM) treated in the Brazilian private healthcare system compared with public institutions, according to an ePoster presented at European Hematology Association 2021 Virtual Meeting.

The observational, retrospective study included 943 patients diagnosed with active MM between January 2008 and December 2016 at 17 public (43.7%), private (49.3%), and hybrid (7.0%) medical centers in Brazil.

Median overall survival was 75.9 months for patients at private institutions compared with 63.3 months (P=.007) for patients at public institutions.

About half of patients (47.9%) were eligible for stem cell transplantation. Proteasome inhibitor regimens were used by 50% of patients at private centers, 11% of patients at public centers, and 8% of patients at hybrid centers. In contrast, immunomodulator regimens were used by 39% of patients at private centers, 71% of patients at public centers, and 80% of patients at hybrid centers.

During second-line treatment, proteasome inhibitor regimens accounted for 46% at private centers, 31% at public centers, and 17% at hybrid centers; immunomodulatory regimens accounted for 27%, 57%, and 61%, respectively. Less than 1% of patients had been treated with carfilzomib, daratumumab, ixazomib, and pomalidomide.

Among transplant eligible patients the median overall survival was not significantly different between private and public institutions (106.2 months vs. 87.1 months; P=.179); among ineligible patients the median overall survival was 63.4 months for private institutions compared with 44.3 months for public institutions (P=.050).

The researchers noted that disease staging and treatment response were independent overall survival predictors, regardless of reimbursement setting and transplant eligibility.

“These preliminary results raise the hypothesis that the superior overall survival among patients in the private healthcare system may be due to a wider availability of these therapies,” the researchers wrote in their ePoster. “Final analysis could help in understanding the influence of treatment regimens on public and private settings in Brazil, with a favorable impact on the MM patient’s management.”