The investigators utilized the National Inpatient Sample (NIS) database to measure the hospitalization burden at the end of life for U.S. patients with MM. The NIS database records approximately 20% of admissions and provides weighted estimates based on these figures. These data were compared with rates of MM-related mortality between 2002 and 2014 via reports from the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI).
The CDC and NCI reported a total of 144,105 deaths from MM, ranging from 10,913 in 2022 to 12,112 in 2014. During this time, a total of 233,932 hospitalizations for MM were recorded by the NIS database (unweighted), of which 14,770 of these patients died in the hospital, or 6.3% of total MM-related hospitalizations. Utilizing these figures, a weighted sample of 69,823 in-hospital deaths from MM were identified during the study period. The researchers estimate that nearly half (48.4%) of patients with MM died in the hospital, ranging from 54% of deaths in 2002 to 41.6% in 2014 (P<0.01).
Hospitalization for MM was also linked to increase resource utilization. About 35% of hospitalized patients with MM who later died in the hospital received blood transfusion. Palliative care or hospice were consulted in 5.3% of hospitalizations in 2002 and 33.57% in 2014. Infections occurred in 45% of patients. The median cost of hospitalization prior to in-hospital mortality increased from $48,709 in 2002 to $104,115 in 2014 (P<0.01).
“Despite a decrease in the percentage of inpatient deaths over time, greater than 40% of patients with myeloma continue to die in the hospital, with significant transfusion requirements and infections at the end of life. This comes with an increased cost to the healthcare system,” the researchers concluded. “While palliative care involvement at the end of life has also increased over time, earlier involvement of palliative care and incorporation of transfusion support within hospice services may decrease the number of myeloma patients dying in the hospital and, therefore, the overall burden and cost of care.”