Estimation of economic costs associated with transfusion dependence in adults with MDS^*

ABSTRACT

Objective: To examine the economic burden of myelodysplastic syndromes (MDS) and the incremental cost of transfusion dependence.

Research design and methods: Adults with evidence of MDS were identified between 05/01/2000 and 09/30/2003 from a longitudinal, retrospective claims database for a large, geographically diverse US health plan and their medical histories were followed for at least 6 months. Patients were classified as transfusion-dependent (MDS-TD) or transfusion-independent (MDS-TI).

Main outcome measures: Variables were categorized as demographic, health status, utilization, or cost. Utilization (inpatient hospitalizations, outpatient facility visits, emergency department visits, and physician office visits) is reported as the mean and median numbers of each specified encounter per subject. Costs were measured as the sum of patient and plan liability. All variables were analyzed descriptively, and appropriate statistical tests were used to compare the MDS-TD and MDS-TI cohorts. Pharmacy, medical, and total health care costs, adjusted for demographics and comorbidity, were estimated using gamma regression with a log link.

Results: The MDS-TI cohort consisted of 2864 patients, and the MDS-TD cohort comprised 336 patients. Mean age for the entire study sample was 70.2 years. The MDS-TI cohort tended to receive most of its medical care at physicians’ offices, whereas the MDS-TD cohort received nearly as much medical care at outpatient facilities (e.g., infusion clinics, hospital outpatient clinics) as it did in physicians’ offices. The MDS-TD cohort had significantly higher mean annual costs: pharmacy, $4457 vs. $2926; medical, $50,663 vs. $17,469; total, $51,066 vs. $19,811 (p < 0.001 for all comparisons). Thus, transfusion dependence was associated with an incremental cost of $31,255 per patient per year. Some limitations inherent to using claims data and diagnosis codes for research apply to this study.

Conclusions: This study demonstrated that an important consequence of transfusion dependence for MDS patients was markedly greater use of, and consequently higher costs associated with, inpatient and outpatient services. Continued research and efforts to develop biologic and pharmaceutical therapies may help more patients achieve transfusion independence, thereby reducing the financial burden of MDS.

Key words::

• Blood transfusion
• Health care costs
• Myelodysplastic syndromes (MDS)

Transparency

Declaration of funding

Funding for this study was provided by Celgene.

Declaration of financial/other relationships

All authors have disclosed that they have no relevant financial relationships.

All peer reviewers receive honoraria from CMRO for their review work. The peer reviewers have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors thank Jesse Potash and Victoria Zarotsky at i3 Innovus for assistance with preparation of this manuscript.

Notes

* A portion of the preliminary analysis upon which this paper is based was presented as a poster, ‘Economic burden of transfusion dependence in patients with myelodysplastic syndromes’, at the 2005 American Society of Clinical Oncology Annual Meeting, May 13–17 in Orlando, FL, USA. An abstract on this topic was presented at the 9th International Symposium on Myelodysplastic Syndromes in Florence, Italy, May 16–19, 2007 and was published in Clinical Advances in Hematology & Oncology 5(7 Suppl. 10):7.