ADVERTISEMENT
Clinical and Economic Burden of First-Line Chemoimmunotherapy for CLL/SLL
Between high-risk and nonhigh-risk patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) initiating first-line chemoimmunotherapy, high-risk patients experience greater risk of next treatment or death, treatment failure, and higher costs, according to a real-world study presented at the 2021 ASCO Annual Meeting.
The economic burden for patients with CLL or SLL who have high-risk genetic abnormalities, often leading to inferior responses to chemoimmunotherapy, is uncertain. “This study aimed to compare real world clinical and economic outcomes in high-risk and perceived nonhigh-risk patients initiating [first-line] chemoimmunotherapy” wrote Lori Leslie, MD, John Theurer Cancer Center, Hackensack, NJ, and colleagues.
Patients with CLL or SLL who initiated first-line chemoimmunotherapy between January 2007 and July 2019 and who underwent prognostic testing to classify them as high-risk or nonhigh-risk were identified from the HealthCore Integrated Research Database.
Patients included in this study had ≥12 of pre-index and ≥30 days of post-index eligibility. The primary study outcomes were testing rate, time to next treatment or death, time to treatment failure, and total plan paid costs per patient per month in the first-line treatment period. Adjusted hazard ratio or rate ratio were calculated using Cox proportional hazard models and generalized linear models.
A total of 1808 patients were included in this study, of whom 612 were FISH or IGHV tested. Rates of testing increased from 30% to 44% between 2007 and 2019. In 253 patients whose risk status was available, 119 were high-risk, while 134 were nonhigh-risk, and 80% were initiating first-line bendamustine-rituximab/fludarabine, cyclophosphamide, rituximab-based therapy in both cohorts.
The median follow up was 26.4 months for high-risk patients, and 25.8 months for nonhigh-risk patients. High-risk patients had 65% higher risk of death/time to next treatment (median time: 2.4 vs 3.7 years), and risk of treatment failure (median time: 3 vs 4.9 years) compared to nonhigh-risk patients.
High-risk patients in the first-line period had higher costs per patient per month, totaling $12,194, while costs per patient per month for nonhigh-risk patients totaled $9055.
“Initiating [first-line] chemoimmunotherapy among [high-risk] patients with CLL/SLL was associated with increased risks of [next treatment]/death, [trestment failure], and higher costs compared to [nonhigh-risk] patients identified by FISH only” wrote Dr Leslie and colleagues, concluding, “Assessment of cytogenetic/molecular risk status for appropriate treatment is vital to optimize clinical and economic outcomes, especially in the novel agent era.”—Marta Rybczynski
Leslie LA, Gangan N, Tan H, et al. Clinical and economic burden among patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) receiving first-line (1L) chemoimmunotherapy (CIT) by risk status: A chart-linked claims analysis. Presented at: the 2021 ASCO Annual Meeting; June 4-8, 2021; virtual. Abstract e19505.
