Treatment patterns, healthcare resource utilization, and costs in patients with acute myeloid leukemia in commercially insured and Medicare populations

Abstract

Objective: To describe the setting, duration, and costs of induction and consolidation chemotherapy for adults with newly-diagnosed acute myeloid leukemia (AML), who are candidates for standard induction chemotherapy, in the US.

Methods: Adults newly-diagnosed with AML who received standard induction chemotherapy in an inpatient setting were identified from the Truven Health Analytics MarketScan (2006–2015) and SEER-Medicare (2007–2011) databases. Patients were observed from induction therapy start to the first of hematopoietic stem cell transplant, 180 days after induction discharge, health plan enrollment/data availability end, or death. Induction and consolidation chemotherapy were identified using Diagnosis-Related Group codes (chemotherapy with acute leukemia) or procedure codes for AML chemotherapy administration. AML treatment episode setting (inpatient or outpatient), duration, and costs (2015 USD, payers’ perspective) were described for commercially insured patients and Medicare beneficiaries.

Results: In total, 459 commercially insured patients and 563 Medicare beneficiaries (mean age = 54 and 66 years; 53% and 54% male; respectively) were identified. For induction therapy, mean costs were $145,189 for commercially insured patients and $85,734 for Medicare beneficiaries, and median inpatient duration was 31 days (both). Following induction, 64% of commercially insured patients and 53% of Medicare beneficiaries had ≥1 consolidation cycle; 75% and 65% of consolidation cycles were in an inpatient setting, respectively. For consolidation cycles, in the inpatient setting, mean costs were $28,137 for commercially insured patients and $28,843 for Medicare beneficiaries, median cycle duration was 6 days (both); in the outpatient setting, mean costs were $11,271 for commercially insured patients and $5,803 Medicare beneficiaries, median duration was 5 days (both).

Limitations: Granular information on chemotherapy type administered was unavailable.

Conclusions: This is the first exploratory study providing a complete picture of recent AML treatment patterns and management costs among commercially insured patients and Medicare beneficiaries. There is substantial heterogeneity in the management and costs of AML.

Keywords:

• Acute myeloid leukemia
• induction therapy
• consolidation cycle
• hematopoietic stem cell transplant
• treatment patterns
• healthcare resource utilization
• costs

Transparency

Declaration of funding

Funding for this research was provided by Novartis.

Declaration of financial/other relationships

EMS has received consultancy fees from Novartis. GB, OB, and GJJ are employees of Novartis. AG, DLV, PGS, and SS are employees of Analysis Group, Inc., which has received consultancy fees from Novartis. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Medical writing assistance was provided by Shelley Batts, PhD, an employee of Analysis Group, Inc., which has received funding from Novartis.

Previous presentation

A synopsis of the current research was presented in poster format at the Academy of Managed Care Pharmacy (AMCP) Managed Care and Specialty Pharmacy annual meeting in Denver, CO, March 27–30, 2017, and at the ISPOR 22nd Annual International Meeting, in Boston, MA, May 20–24, 2017.