Transplant group shows 38% lower mortality risk than non-transplant group

Cost-effectiveness confirmed despite higher medical expenses

From left: Professors Min Chang-ki, Park Sung-soo and Lee Jung-yeon of the Hematology Hospital at Seoul St. Mary's Hospital, and Professor Choi Su-in of the Department of Pharmacology at the Catholic University of Korea College of Medicine. [Seoul St. Mary's Hospital]
From left: Professors Min Chang-ki, Park Sung-soo and Lee Jung-yeon of the Hematology Hospital at Seoul St. Mary's Hospital, and Professor Choi Su-in of the Department of Pharmacology at the Catholic University of Korea College of Medicine. [Seoul St. Mary's Hospital]

Elderly patients with multiple myeloma should not be excluded from autologous hematopoietic stem cell transplantation based on age alone, according to a new domestic study.

A research team led by Professor Min Chang-ki of the Hematology Hospital at Catholic University of Korea's Seoul St. Mary's Hospital announced Tuesday the findings of an analysis examining the effectiveness of autologous hematopoietic stem cell transplantation in multiple myeloma patients aged 65 to 69, using claims data from the Health Insurance Review and Assessment Service. Professor Choi Su-in of the Department of Pharmacology at the Catholic University of Korea College of Medicine served as co-corresponding author, and Professor Lee Jung-yeon of the Hematology Hospital at Seoul St. Mary's Hospital was the first author.

Multiple myeloma is a blood cancer in which plasma cells in the bone marrow proliferate malignantly. The number of new cases in South Korea rose roughly fourfold — from 492 in 2000 to 1,961 in 2022 — and about 90 percent of all patients are 60 or older. Although autologous hematopoietic stem cell transplantation is considered a primary first-line treatment, its use in older patients has long been debated due to concerns about treatment toxicity and cost.

The research team noted that because existing evidence has been concentrated in Western studies, there was a need to assess both the transplant's effectiveness and its economic viability in the domestic medical environment, where drug prices and healthcare cost structures differ.

The team analyzed 735 patients aged 65 to 69 newly diagnosed with multiple myeloma between 2009 and 2024. Of these, 458 received autologous hematopoietic stem cell transplantation following induction therapy with bortezomib, thalidomide and dexamethasone, while 277 received drug treatment only without transplantation.

Survival duration and medical costs were estimated using a semi-Markov model that reflects the stages patients go through — treatment, relapse and death. This allowed the team to compare long-term survival and cost-effectiveness beyond the actual observation period.

The analysis found that the four-year survival rate in the transplant group was 67.8 percent, 12.8 percentage points higher than the 55.0 percent recorded in the non-transplant group. The transplant group also showed a 38.0 percent lower risk of death, and the time to next treatment was 29.8 months, compared with 19.7 months in the non-transplant group — a difference of 10.1 months.

Cost-effectiveness was also confirmed. The transplant group incurred about 29.9 million won ($22,100) more in total medical costs than the non-transplant group, but gained 0.71 additional quality-adjusted life years. The incremental cost per quality-adjusted life year gained was approximately 42.4 million won, below the domestic threshold of about 52.4 million won applied in the study. In 1,000 simulations, the probability that transplantation was cost-effective stood at 70.3 percent.

The research team also identified the relatively low domestic transplant cost — ranging from about 29.7 million to 32 million won — as a factor boosting cost-effectiveness, compared with the average inpatient transplant cost of about 232.7 million won in the United States. Although national health insurance coverage for transplantation has been expanded to patients up to age 70, only 62.3 percent of eligible patients actually received the procedure.

"This analysis used domestic data to show that transplantation extends survival in patients aged 65 to 69 and that its cost falls within a range our healthcare system can sustain," Min said. "The decision to transplant should be based on the patient's overall condition, not age."

"Because this evidence was built on nationwide claims data tailored to domestic conditions, we expect it can also inform future discussions on national health insurance coverage policy," Choi said.

The study was conducted as a multicenter research project under the Catholic Myeloma Research Network (CAREMM), and the findings were published online ahead of print in Value in Health, the official journal of the International Society for Pharmacoeconomics and Outcomes Research. Full publication is scheduled for October.


woo@heraldcorp.com