The Fiscal Consequences Attributed to Multiple Myeloma in Slovakia: There is No Small Disease

Abstract Background The incidence of multiple myeloma (MM) is rising in ageing populations. New therapies have improved survival but are among the most expensive in oncology. The consequences of MM for government revenues and expenditures in Slovakia have not been quantified. Methods A government-perspective fiscal model compared people with MM with the general population of the same age in Slovakia for 2009–2023, with projections to 2030. Each annual result combined gross public healthcare expenditure, before confidential rebates, with the present value of the lifetime tax and contribution revenue not collected, and of the additional sick-leave and disability transfers, for newly diagnosed patients and their caregivers. One-way sensitivity analyses were performed. Results In 2023, the total fiscal burden was €32 210 398: healthcare expenditure €25 848 178 (80.2%), revenue not collected €6 230 764 (19.3%) and additional transfers €131 456 (0.4%). The cumulative burden for 2009–2023 was €387.0 million (healthcare €304.6 million, revenue €80.0 million, transfers €2.4 million). Gross earnings losses (societal perspective, not part of the fiscal burden) were €82.4 million. The burden is projected to reach €39 533 502 in 2030 (+ 22.7%). In sensitivity analyses, the 2023 total ranged from €28.5 million to €44.5 million and was most sensitive to the discount rate and to projected healthcare expenditure. Conclusions MM imposes a substantial fiscal burden on Slovak public finances, which is projected to grow. Most of it is healthcare expenditure; social transfers account for less than 1%. The estimates provide a baseline for fiscal evaluations of specific interventions.