MP467COST EFFECTIVENESS OF TREATMENT OF MULTIPLE MYELOMA WITH FILTERS HIGH CUT OFF

Abstract

Introduction and Aims: Treatment of Multiple Myeloma with filters high cut off was started in 2007; Grima published a study based on a cost-effectiveness model, comparing treatment with HCO dialysis with conventional dialysis. The results of that study showed a higher life expectancy and cost savings as chronic dialysis was avoided. The model predicted a survival of 20 months in standard dialysis, compared with a survival of 34 months with the use of filters HCO, which also provide a higher quality of life because the treatment does not require dialysis. Working hypothesis: The HCO hemodialysis is a cost-efficient treatment. Objective: To demonstrate that a combination treatment of chemotherapy and High cut off dialysis improves patient survival and quality of life, besides saving costs because it avoids chronic dialysis. Methods: 13 treatments with HCO hemodialysis for acute renal failure secondary to Multiple Myeloma took place in our hospital. The dialyzer used in all cases is a HCO filter of 2.1m2 Theralite®. Initially, daily dialysis were performed during 6 sessions; afterwards, dialysis on alternate days was performed until getting levels of free light chains under 500 mg/L or recovering a renal function to avoid dialysis. Duration of every dialysis was 6 hours Monitoring includes: renal function, blood free light chain, calcium, phosphorus, albumin and ions. Results: We report our experience in the period between July 2011 and February 2015. 13 treatments were performed at 12 patients with high cut off hemodialysis.151 dialysis sessions were held in total, the number of days remaining in dialysis treatment with HCO filter was, 11.6 on average, with a range between 6 and 27 sessions. The cost of a dialysis with HCO filter is 924.76 euros, the total number of sessions considering all the 13 treatments is 151, which supposes 11.6 sessions per patient and a total cost of 10,866 euros per treatment. The conventional dialysis cost per session in our hospital during the years 2011-2014 (the main period of our study), has been 87.11 euros on average per session. A patient usually requires 3 sessions per week or 156 sessions per year, so the total cost is about 13.589 euros. According to the Grima work, the survival of patients with multiple myeloma in dialysis is 20 months on average, which represents a cost of 260 sessions x 87.11 euros: 22,648 euros in total; consequently, there is an estimate saving of 11.782 euros. Conclusions: 1.- The combined treatment of chemotherapy and HCO hemodialysis proved to be effective for renal failure secondary to multiple myeloma in 77% of cases.2.- The treatment is cost-effective; cost savings can be estimated in more than 11,000 euros/patient.