Healthcare Costs and Utilization for Patients Age 50 to 64 Years with Acute Myeloid Leukemia Treated with Chemotherapy or with Chemotherapy and Allogeneic Hematopoietic Cell Transplantation

Abstract

The primary aim of this study was to describe healthcare costs and utilization during the first year after a diagnosis of acute myeloid leukemia (AML) for privately insured non-Medicare patients in the United States (US) aged 50-64 years who were treated with either chemotherapy or chemotherapy and allogeneic hematopoietic cell transplantation (alloHCT). MarketScan (Truven Health Analytics) adjudicated total payments for inpatient, outpatient and prescription drug claims from 2007-2011 were used to estimate costs from the health system perspective. Stabilized inverse propensity score weights were constructed using logistic regression to account for differential selection of alloHCT over chemotherapy. Weighted generalized linear models (GLM) adjusted costs and utilization (hospitalizations, inpatient days and outpatient visit-days) for differences in age, sex, diagnosis year, region, insurance plan type, Elixhauser Comorbidity Index (ECI) and 60-day pre-diagnosis costs. Because mortality data were not available, models could not be adjusted for survival times. Among 29,915 patients with a primary diagnosis of AML, a total of 985 patients met inclusion criteria (774 [79%] receiving chemotherapy alone and 211 [21%] alloHCT). Adjusted mean one-year costs were $280,788 for chemotherapy and $544,178 for alloHCT. Patients receiving chemotherapy alone had a mean of 4 hospitalizations, 52.9 inpatient days and 52.4 outpatient visits in the year following AML diagnosis; patients receiving alloHCT had 5 hospitalizations, 92.5 inpatient days and 74.5 outpatient visits. Treating AML in the first year after diagnosis incurs substantial health care costs and utilization with chemotherapy alone and with alloHCT. Our analysis informs health care providers, policy makers and payers so they can better understand treatment costs and utilization for privately-insured patients age 50-64 with AML.

Treatment patterns and healthcare resource utilization in patients withFLT3‐mutated and wild‐type acute myeloid leukemia: A medical chart study

“…When comparing the observed treatments with those recommended by the NCCN, 24 more than 50% of ND patients aged 18-64, more than 28% of ND patients aged ≥65 years, and more than 39%…”

Analysis of the cost-effectiveness of treatment strategies for CML with incorporation of treatment discontinuation

“…Because generic imatinib is widely available, we also performed the analysis using our Markov model with the costs calculated by other investigators, 8,20 in which the estimated cost of imatinib was much lower, assuming widespread use of generic compounds (supplemental Table 1). The costs for office visits 20 and allogeneic transplantation 24 in the United States were extracted from published studies. For Japanese analysis, we defined costs for office visits according to standard practice in Japan.…”

The Evolution of Care for Acute Myeloid Leukemia and the Challenges of Defining Value

“…2,5 Chromosome alterations and complex karyotype (described as > 3 chromosomal abnormalities) are associated with poor response to therapy and reduced survival. The presence of other cytogenetic abnormalities, such as t (8;21) or inv (16) in core-binding factor AML indicate longer disease remission and survival. Approximately 40% to 50% of all AML cases are cytogenetically normal AML (CN-AML).…”

“…The KIT gene encodes a type III tyrosine kinase receptor glycoprotein that is responsible for the growth, proliferation, and differentiation of hematopoietic cells, melanocytes, and germ cells. This mutation is rare in AML (<5%) but present in 20% to 25% in AML with t(8;21) and 30% in AML with inv (16). KIT mutations are associated with an increased risk of relapse and negate the good prognosis of core-binding factor AML.…”