Treatment sequences and drug costs from diagnosis to death in multiple myeloma.

Novel therapies for multiple myeloma (MM) have improved patient survival, but their high costs strain healthcare budgets. End-of-life phases of treatment are generally the most expensive, however, these high costs may be less justifiable in the context of a less pronounced clinical benefit. To manage drug expenses effectively, detailed information on end-of-life drug administration and costs are crucial. In this retrospective study, we analysed treatment sequences and drug costs from 96 MM patients in the Netherlands who died between January 2017 and July 2019. Patients received up to 16 lines of therapy (median overall survival: 56.5 months), with average lifetime costs of €209 871 (€3111/month; range: €3942-€776 185) for anti-MM drugs. About 85% of patients received anti-MM treatment in the last 3 months before death, incurring costs of €20 761 (range: €70-€50 122; 10% of total). Half of the patients received anti-MM treatment in the last 14 days, mainly fully oral regimens (66%). End-of-life treatment costs are substantial despite limited survival benefits. The use of expensive treatment options is expected to increase costs further. These data serve as a reference point for future cost studies, and further research is needed to identify factors predicting the efficacy and clinical benefit of continuing end-of-life therapy.

Uncertainties in transpiration estimates.

arising from S. Jasechko et al. Nature 496, 347-350 (2013)10.1038/nature11983How best to assess the respective importance of plant transpiration over evaporation from open waters, soils and short-term storage such as tree canopies and understories (interception) has long been debated. On the basis of data from lake catchments, Jasechko et al. conclude that transpiration accounts for 80-90% of total land evaporation globally (Fig. 1a). However, another choice of input data, together with more conservative accounting of the related uncertainties, reduces and widens the transpiration ratio estimation to 35-80%. Hence, climate models do not necessarily conflict with observations, but more measurements on the catchment scale are needed to reduce the uncertainty range. There is a Reply to this Brief Communications Arising by Jasechko, S. et al. Nature 506, http://dx.doi.org/10.1038/nature12926 (2014).