Economic burden of treatment failure in chronic lymphocytic leukemia patients

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
• treatment failure
• healthcare costs

Transparency

Declaration of funding

This study was funded by Janssen Scientific Affairs LLC.

Author contributions: All authors contributed to the conception and design of the study, the analysis and interpretation of the data, the drafting of the paper and revising it critically for intellectual content, and provided their final approval of the version to be published. All authors agree to be accountable for all aspects of the work presented in this manuscript.

Declaration of financial/other relationships

S.W. and M.S. have disclosed that they are employees of Johnson & Johnson and may hold J&J stocks. B.E., M.H.L., H.R. and P.L. have disclosed that they are employees of Analysis Group Inc., a consulting company that has received research funds from Janssen Scientific Affairs LLC to conduct this study.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgements

Previous presentation: Part of the material in this manuscript has been presented at the International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2017 Meeting, New York City, NY, USA, 12–15 May 2017. Another part was accepted for publication at the American Society of Clinical Oncology (ASCO) 2017 Meeting, Chicago, IL, USA, 2–6 June 2017.