An Economic Model to Establish the Costs Associated With Routes to Presentation for Patients With Multiple Myeloma in the United Kingdom

Alex Porteous, Scott Gibson, Lucy Eddowes, Mark T Drayson, Guy Pratt, Stella Bowcock, Fenella Willis, Hannah Parkin, Suzanne Renwick, Ira Laketic-Ljubojevic, Debra Howell, Alex Smith, Simon Stern

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Patients with myeloma often face significant diagnostic delay, with up to one-third of UK patients diagnosed after an emergency presentation (EP). Compared with other routes, patients presenting as an emergency have more advanced disease, increased complications, and poorer prognosis.

METHODS: An economic model was developed using a decision-tree framework and lifetime time horizon to estimate costs related to different presentation routes (EP, general practitioner [GP] 2-week wait, GP urgent, GP routine, and consultant to consultant) for UK patients diagnosed as having myeloma. After diagnosis, patients received one of 3 first-line management options (observation, active treatment, or end-of-life care). Inputs were derived from UK health technology assessments and targeted literature reviews, or based on authors' clinical experience where data were unavailable. Active treatment, complication, and end-of-life care costs were included.

RESULTS: The average per-patient cost of treating myeloma (across all routes) was estimated at £146 261. The average per-patient cost associated with EP (£152 677) was the highest; differences were minimal compared with GP 2-week wait (£149 631) and consultant to consultant (£147 237). GP urgent (£140 025) and GP routine (£130 212) were associated with marginally lower costs. Complication (£42 252) and end-of-life care (£11 273) costs were numerically higher for EP than other routes (£25 021-£38 170 and £9772-£10 458, respectively).

CONCLUSIONS: An economic benefit may be associated with earlier diagnosis, gained via reduced complication and end-of-life care costs. Strategies to expedite myeloma diagnosis and minimize EPs have the potential to improve patient outcomes and may result in long-term savings that could offset any upfront costs associated with their implementation.

Original languageEnglish
Pages (from-to)27-33
Number of pages7
JournalValue in Health Regional Issues
Early online date24 Feb 2023
Publication statusPublished - May 2023

Bibliographical note

©2023 International Society for Health Economics and Outcomes Research.


  • Humans
  • Multiple Myeloma/diagnosis
  • Delayed Diagnosis
  • United Kingdom
  • Models, Economic

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