For patients with chronic myeloid leukemia (CML), switching to the subsequent lines of therapy is frequent due to previous tyrosine kinase inhibitor (TKI) intolerance and results in high medical costs, according to a study presented at the 62nd ASH Annual Meeting and Exposition.
This study assessed treatment patterns in patients with CML receiving ≥3 lines of TKI therapy and the associated health care resource and costs. Results were presented by Ehab Atallah, MD, Medical College of Wisconsin, Wauwatosa.
“As we all know, the prognosis of CML has improved greatly with the development of new treatments. However, despite advances in [TKI] therapy for CML there remains a proportion of patients with CML in chronic phase who are resistant to or intolerant to 1st and 2nd generation TKIs,” explained Dr Atallah during his presentation.
“A good understanding of the most recent real-world patterns of care in these patients and their impact on healthcare resource utilization and costs is necessary in order to provide context for assessing the potential benefits of new treatments undergoing clinical development,” he continued.
Using the IBM MarketScan Commercial and Medicare Supplement databases, 48,168 adult patients with CML in the US who received ≥3 lines of TKI therapy were identified.
Treatment patterns were observed from diagnosis. All-cause health care resource utilization (HRU) and costs were measured during the course of third-line therapy and between third-line therapy initiation and end of follow-up. HRU was reported using monthly incidence rates per 100 patients and costs were reported per-patient-per-month (PPPM) from a payer’s perspective.
Of the 48,168 patients identified, 296 initiated third-line therapy. The mean follow-up from diagnosis was 58.5 months and the mean follow-up from third-line therapy initiation was 24.5 months.
The most common sequences of TKI therapies from first-line to third-line were: imatinib to dasatinib to nilotinib (28%); imatinib to nilotinib to dasatinib (16%); imatinib to dasatinib to imatinib (9%); and dasatinib to imatinib to nilotinib (5%). The mean duration of first-line, second-line, and third-line therapy was 14.9 months, 10.4 months, and 15.6 months, respectively.
The most common TKI therapies received at each line were imatinib in first-line (65%), dasatinib in second-line (49%), and nilotinib in third-line (36%). The mean treatment-free period between first-line and second-line was 1.3 months, between second-line and third-line was 2.6 months, and between third-line and fourth-line was 1.5 months.
The monthly incidence rate per 100 patients during third-line therapy was 3.4 inpatient admissions, 21.2 inpatient days, 248.8 outpatient days, and 10.2 emergency department visits. Mean total costs were $15,192 PPPM, with pharmacy costs accounting for 69% and medical costs accounting for 31%.
For third-line therapy and later, the monthly incidence rate per 100 patients was 3.5 inpatient admissions, 28.7 inpatient days, 252.2 outpatient days, and 10 emergency department visits. Mean total costs were $18,767 PPPM, with pharmacy costs accounting for 49%. Medical costs were mainly driven by inpatient costs.
“Our findings support the need for better treatment options in patients with CML who are receiving later lines of therapy,” Dr Atallah concluded.—Janelle Bradley
Atallah E, Maegawa R, Latremouille-Viau D, et al. Real-World Treatment Patterns, Healthcare Resource Utilization and Associated Costs Among Patients with Chronic Myeloid Leukemia in Later Lines of Therapy. Presented at: the virtual 62nd ASH Annual Meeting and Exposition; December 5-8, 2020. Abstract 216.
