Economic burden of treatment failure in chronic lymphocytic leukemia patients

Curr Med Res Opin. 2018 Jun;34(6):1135-1142. doi: 10.1080/03007995.2018.1464904. Epub 2018 Apr 25.

Abstract

Objective: This study assessed healthcare costs of first-line treatment failure (TF) in patients with chronic lymphocytic leukemia (CLL), a subtype of non-Hodgkin's lymphoma.

Methods: Pre-diagnosis treatment-naïve adults with ≥2 CLL diagnoses initiated on an antineoplastic agent (index date) after their first CLL diagnosis with ≥12 and ≥6 months of continuous observation pre- and post-index, respectively, were selected from the Truven Health MarketScan Research Databases. Patients had no solid malignancies in the pre-index period nor selected blood malignancies at any time. Initial therapy included antineoplastic agents initiated in the first 30 days post-index. TF occurred at the earliest of: initiation of a new antineoplastic agent, treatment resumption following a ≥3 month break, non-chemotherapy intervention (stem cell transplant or radiotherapy), hospice care or hospital mortality. The cost of TF was evaluated as the healthcare cost difference between patients with and without first-line TF using ordinary least square regressions adjusted for baseline characteristics. Non-parametric bootstrap was used to evaluate statistical significance.

Results: Among 2226 patients identified (mean age: 68 years; female: 41%), 46% experienced first-line TF. The average TF cost was $3011 per patient per month (p < .001). When stratifying patients by event indicating TF and by most common therapies, non-chemotherapy intervention ($7582 per patient per month; p < .0001) and fludarabine/cyclophosphamide/rituximab ($4758; p < .001) were associated with the highest TF cost, respectively.

Conclusions: The cost of first-line TF is high and varies across first-line therapies. This should be considered when selecting the initial therapy in these patients.

Keywords: Chronic lymphocytic leukemia; healthcare costs; treatment failure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents* / economics
  • Antineoplastic Agents* / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols* / economics
  • Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
  • Cost of Illness*
  • Female
  • Health Care Costs / statistics & numerical data*
  • Hospital Mortality
  • Humans
  • Leukemia, Lymphocytic, Chronic, B-Cell* / economics
  • Leukemia, Lymphocytic, Chronic, B-Cell* / mortality
  • Leukemia, Lymphocytic, Chronic, B-Cell* / therapy
  • Male
  • Middle Aged
  • Survival Analysis
  • Treatment Failure
  • United States / epidemiology

Substances

  • Antineoplastic Agents