Healthcare utilization in patients with higher-risk MDS/low-blast count AML treated with azacitidine in the ‘real-world’

Abstract

Despite the adoption of azacitidine (AZA) in higher-risk MDS/low-blast count AML, limited ‘real-world’ data on resource utilization and toxicity exist. We linked the Ontario AZA-MDS registry to population-based administrative databases. Among 877 patients in the registry, 705 (80.4%) had at least one emergency department (ED) visit, 290 (33.1%) had an ED visit during their first cycle and 680 patients (77.5%) had at least one hospitalization (mean length 17.7 days, 95% CI 16.3–19.1). Older age, rurality, non-response to AZA, transfusion dependence, IPSS score, and greater comorbidity were independent predictors of increased ED visits; while greater comorbidity, non-response to AZA, and transfusion dependence were associated with longer hospitalization. When restricted to receiving ≥3 cycles, hospitalization during the first cycle was associated with increased risk of death. Our analysis of ‘real-world’ patients treated with AZA demonstrates significant healthcare utilization and increased risk of death for patients hospitalized during their first cycle. These results will inform patients/providers about ‘real-world’ toxicities of AZA.

Keywords:

• Myelodysplastic syndromes
• myeloid leukemia
• health services
• azacitidine

Acknowledgements

We would like to acknowledge the support of the New Drug Funding Program at Cancer Care Ontario for their assistance in data collection and preparation of the data for analysis. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences (ICES) or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.

Disclosure statement

RB received research funding from Celgene Canada and Otsuka and participated in advisory boards for Celgene Canada. LM participated in advisory boards for Celgene Canada. The remaining authors declare no relevant conflicts of interest.

Additional information

Funding

This study was conducted with the support of the Ontario Institute for Cancer Research through funding provided by the Government of Ontario. This study was also supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).