A three nation East Asian study has found that the speed at which first-line innovative therapies are covered and administered to the patients, by national health insurance schemes, significantly affects survival among patients with multiple myeloma, according to a report about the study published in Korea Biomedical Review.
The new study “Healthcare Jurisdiction as a Determinant of Real-World Survival in Transplant-Ineligible Multiple Myeloma: Lessons From a Three-Country East Asian Comparison” published in a recent issue of the European Journal of Haematology analysed real-world overall survival in 1,591 newly diagnosed, transplant-ineligible multiple myeloma patients who initiated first-line treatment between 1 January and 31 December 2020.
Among the three East Asian countries (Japan, Taiwan and South Korea) with comparable gross domestic product per capita and healthcare spending, Japan recorded significantly higher survival rates than Korea and Taiwan, where reimbursement for novel therapies came later.
The study was led by researchers of the Catholic University of Korea Seoul, Samsung Medical Center, and Chonnam National University Hospital. The study included 700 patients from Korea, 446 patients from Taiwan, and 445 patients from Japan.
After adjusting for all variable clinical factors, the researchers found that Japanese patients achieved markedly superior overall survival compared with patients in South Korea and Taiwan.
Adjusted hazard ratio analysis showed that the risk of death among Japanese patients was 75.9% lower than that of Taiwanese patients. At the same time, survival outcomes between Korea and Taiwan were nearly identical.
Restricted mean survival time analysis over 48 months also demonstrated that Japanese patients survived an average of 14.4 months longer than patients in Korea or Taiwan.
The survival gap widened over time. At 12 months, overall survival rates were 91.8% in Japan, 71.3% in Korea, and 67.3% in Taiwan. At 24 months, the rates were 86.8%, 53.3%, and 53.9% respectively.
By 48 months, Japan maintained a four-year survival rate of 78.3% percent, while survival had fallen to 34.8% in Korea and 37.4% in Taiwan—a more than twofold difference. Timing of first-line daratumumab reimbursement was identified as key factor
The researchers attributed the striking survival differences primarily to the timing of reimbursement and patient access to innovative antibody therapies such as daratumumab.
Professor Jung Sung-hoon of Chonnam National University Hwasun Hospital, an author of the study, , noted that the findings provide objective evidence that even among countries with similar levels of economic development and universal health insurance systems, population-level survival can differ substantially depending on how quickly innovative therapies supported by global clinical trials are reimbursed.
“The findings highlight the urgent need to shorten the time between regulatory approval and reimbursement while incorporating real-world evidence more rapidly into value assessments to improve patient access to new treatments,” he said.