The potential health gain and cost savings of improving adherence in chronic myeloid leukemia

Ector, Geneviève I C G; Govers, Tim M.; Westerweel, Peter E.; Grutters, Janneke P.C.; Blijlevens, Nicole M A

doi:10.1080/10428194.2018.1535113

Cited by 7 publications

(4 citation statements)

References 32 publications

(46 reference statements)

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“…To date, only 2 of the assessments were published. 19,20 Due to the confidentiality of the information, we were limited in the amount of information we could provide on the assessments. Confidentiality is often an issue in early HTA, when commercial viability is assessed.…”

Section: Discussionmentioning

confidence: 99%

Problems and Promises of Health Technologies: The Role of Early Health Economic Modeling

Grutters

Govers

Nijboer

et al. 2019

Int J Health Policy Manag

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Background: To assess whether early health economic modeling helps to distinguish those healthcare innovations that are potentially cost-effective from those that are not potentially cost-effective. We will also study what information is retrieved from the health economic models to inform further development, research and implementation decisions. Methods: We performed secondary analyses on an existing database of 32 health economic modeling assessments of 30 innovations, performed by our group. First, we explored whether the assessments could distinguish innovations with potential cost-effectiveness from innovations without potential cost-effectiveness. Second, we explored which recommendations were made regarding development, implementation and further research of the innovation. Results: Of the 30 innovations, 1 (3%) was an idea that was not yet being developed and 14 (47%) were under development. Eight (27%) innovations had finished development, and another 7 (23%) innovations were on the market. Although all assessments showed that the innovation had the potential to become cost-effective, due to improved patient outcomes, cost savings or both, differences were found in the magnitude of the potential benefits, and the likelihood of reaching this potential. The assessments informed how the innovation could be further developed or positioned to maximize its cost-effectiveness, and informed further research. Conclusion: The early health economic assessments provided insight in the potential cost-effectiveness of an innovation in its intended context, and the associated uncertainty. None of the assessments resulted in a firm ‘no-go’ recommendation, but recommendations could be provided on further research and development in order to maximize value for money.

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Section: Discussionmentioning

confidence: 99%

Problems and Promises of Health Technologies: The Role of Early Health Economic Modeling

Grutters

Govers

Nijboer

et al. 2019

Int J Health Policy Manag

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“…In CML care, treatment decisions increasingly incorporate patient and physician preferences regarding multiple aspects of quality of life, practicality, and cost-effectiveness [ 21 ]. Previous studies in CML have found poor to moderate agreement between physician and patient reports of symptom severity, health status, and pain after TKI discontinuation [ 13 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Patient Versus Physician Perspective in the Management of Chronic Myeloid Leukemia During Treatment with Tyrosine Kinase Inhibitors

Chen,

Wen,

Zeng

et al. 2023

Oncol Ther

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Introduction Chronic myeloid leukemia (CML) is a chronic disease with treatment-free remission (TFR) increasingly regarded as a feasible goal of treatment. However, various factors may influence adherence to international guidelines for CML management. This study aimed to compare the reporting of care between patients with CML and their treating doctors. Methods Parallel patient and physician online surveys were conducted between September 22, 2021, and March 15, 2022, which focused on the perceptions of 1882 adult patients with CML and 305 physicians regarding tyrosine kinase inhibitor (TKI) treatment options, monitoring and toxicities, TFR, and challenges faced. Results Among the enrolled patients, 69.9% received first-line imatinib treatment, 18.6% received nilotinib, and 4.7% received dasatinib. Among the patients treated with imatinib, 36.7% switched to other TKIs due to imatinib resistance/intolerance (71.1%), exploration of more potent TKIs to achieve TFR (8.9%), and treating physicians’ recommendation (14.0%), with a median duration of initial treatment of 14 months [interquartile range (IQR) 6–36]. Most (91.8%) physicians agreed that the breakpoint cluster region–Abelson 1 ( BCR::ABL1 ) transcript level should be assessed every 3 months, but only 42.7% of individuals committed to 3-monthly testing and only 17.8% strictly followed their treating physicians’ recommendation. Half of the patients aimed for TFR; however, just 45.2% of physicians considered TFR as one of the top three goals for their patients. The major concern in obtaining TFR was patients’ adherence. Fatigue was often distressing for patients with TKIs, while physicians were more concerned about platelet and neutrophil counts. A total of 12% and 20.8% of patients reported moderate/severe anxiety and depression, respectively, while only 53.7% of physicians had concerns about their patients’ mental health. During the coronavirus disease 2019 (COVID-19) pandemic, 69.2% of patients reported a reduction in their income. Among these patients, 61.8% maintained their current treatment, while 7.3% switched to cheaper alternatives or discontinued treatment, with over 80% of these patients belonging to the low-income group. Conclusions Overcoming challenges in patient–physician communication and treatment access is key to improving disease management and quality of life, especially for patients with low income. Trial Registration ClinicalTrials.gov identifier NCT05092048. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-023-00255-2.

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“…Enhancing adherence could save health care costs. A Dutch report assessed the potential value of improving both patients’ adherence to TKIs and physicians’ adherence to guidelines [ 63 ]. For each yearly cohort of newly diagnosed patients with CML (160 patients) over a period of 25 years, a cost reduction of approximately US $3.1 million (€2.8 million) and US $1.3 million (€1.2 million) would be possible by improving the patients’ adherence and physicians’ adherence, respectively, to 100%.…”

Section: Discussionmentioning

confidence: 99%

The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach

Ector¹,

Westerweel²,

Hermens³

et al. 2020

J Med Internet Res

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Background With the global rise in chronic health conditions, health care is transforming, and patient empowerment is being emphasized to improve treatment outcomes and reduce health care costs. Patient-centered innovations are needed. We focused on patients with chronic myeloid leukemia (CML), a chronic disease with a generally good long-term prognosis because of the advent of tyrosine kinase inhibitors. However, both medication adherence by patients and guideline adherence by physicians are suboptimal, unnecessarily jeopardizing treatment outcomes. Objective The aim of this study was to develop a patient-centered innovation for patients with CML using a design thinking methodology. Methods The 5 phases of design thinking (ie, empathize, define, ideate, prototype, and test) were completed, and each phase started with the patient. Stakeholders and end users were identified and interviewed, and observations in the care system were made. Using tools in human-centered design, problems were defined and various prototypes of solutions were generated. These were evaluated by patients and stakeholders and then further refined. Results The patients desired (1) insights into their own disease; (2) insights into the symptoms experienced, both in terms of knowledge and comprehension; and (3) improvements in the organization of care delivery. A web-based platform, CMyLife, was developed and pilot-tested. It has multiple features, all targeting parts of the bigger solution, including a website with reliable information and a forum, a guideline app, personal medical records with logs of symptoms and laboratory results (including a molecular marker and linked to the guideline app), tailored feedback based on the patients’ symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home. Conclusions The multifeatured innovation, CMyLife, was developed in a multidisciplinary way and with active patient participation. The aim of developing CMyLife was to give patients the tools to monitor their results, interpret these results, and act on them. With this tool, they are provided with the know-how to consider their results in relation to their personal care process. Whether CMyLife achieves its goal and the evaluation of the added value will be the focus of future studies. CML could become the first malignancy for which patients are able to monitor and manage their disease by themselves.

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The potential health gain and cost savings of improving adherence in chronic myeloid leukemia

Cited by 7 publications

References 32 publications

Problems and Promises of Health Technologies: The Role of Early Health Economic Modeling

Problems and Promises of Health Technologies: The Role of Early Health Economic Modeling

Patient Versus Physician Perspective in the Management of Chronic Myeloid Leukemia During Treatment with Tyrosine Kinase Inhibitors

The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach

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