A retrospective analysis of a large commercial payer database has demonstrated a link between various treatment episodes of acute myeloid leukemia (AML) and substantial economic burden. According to data presented at ASH 2017, healthcare resource use and direct healthcare costs were associated with high-intensity chemotherapy induction, hematopoietic stem cell transplantation (HSCT), and episodes of relapsed or refractory disease in a US commercially insured population.
“Clearly, new therapeutic strategies associated with less economic burden are needed,” said Bruno C. Medeiros, MD, Director, Inpatient Hematology Service, Stanford University School of Medicine, CA, who noted that hospitalization was a major cost driver across all episodes.
Although the incidence of AML has risen 3.1% each year over the past 10 years, detailed real-world cost estimates and comparisons of key AML treatment episodes are rare and are challenging to assemble, Dr Medeiros explained. For this study, he and his colleagues used a healthcare claims database (PharMetrics Plus) and linked charge detail master hospital data to search for adults with AML and ≥2 outpatient claims or ≥1 inpatient claims between January 2008 and March 2016.
Dr Medeiros and colleagues evaluated the treatment episodes, including high-intensity chemotherapy induction (evidence of inpatient high-dose cytarabine plus anthracycline use within 3 months of diagnosis), high-intensity chemotherapy consolidation (evidence of cytarabine use with or without anthracycline within 2 months of high-intensity chemotherapy), low-intensity chemotherapy (evidence of low-intensity cytarabine, anthracycline, 5-azacytidine, decitabine, clofarabine, hydroxyurea, or gemtuzumab ozogamicin use in the outpatient setting within 3 months of diagnosis), HSCT (record of transplant-specific diagnosis or procedure codes), and patients with relapsed or refractory disease (record of an International Classification of Diseases, Ninth Revision diagnosis code [205.02] for relapsed AML after high-intensity chemotherapy, low-intensity chemotherapy, or HSCT).
Hospitalizations Drive Cost of Treatment Episodes
The final study sample consisted of 1542 treatment episodes of high-intensity chemotherapy induction, 591 episodes of high-intensity chemotherapy consolidation, 628 episodes of low-intensity chemotherapy, 1000 cases of HSCT, and 119 patients with relapsed or refractory disease. Patients receiving low-intensity chemotherapy were the oldest (mean age, 64.9 years), and patients receiving high-intensity chemotherapy were the youngest (mean age, 47.0 years).
On average, the total episode cost was highest for HSCT ($329,621), with a mean follow-up of 6.4 months. For patients undergoing HSCT, the hospitalization costs averaged $244,801, whereas physician office visits and outpatient pharmacy costs were $6017 and $11,398, respectively. According to Dr Medeiros and colleagues, 26.9% of patients who had HSCT had ≥1 emergency department visits that did not lead to hospital admission, at an average cost of $1037.
High-intensity chemotherapy induction had the second-highest average episode cost ($198,528), with a mean follow-up of 2.1 months. As Dr Medeiros reported, all high-intensity chemotherapy induction required hospitalization and accounted for most of the high-intensity chemotherapy costs ($178,891), with $2843 attributed to physician office visits and $2868 to outpatient pharmacy costs.
Relapsed or refractory episodes were also associated with high economic burden, with a cost of $145,634 and a mean follow-up of 7.6 months. Hospitalization occurred in 74.8% of patients with relapsed or refractory disease at a cost of $101,420, whereas physician office visits and outpatient pharmacy costs were $3340 and $6108, respectively.
On the other hand, the cost was lowest with treatment episodes involving low-intensity chemotherapy ($53,081), with a 2-month follow-up. High-intensity chemotherapy consolidation costs $73,304 on average, with a mean follow-up of 1.5 months, Dr Medeiros and colleagues noted.