The impact of remission duration on the long-term economic burden of acute myeloid leukemia among patients without hematopoietic stem cell transplant in the United States

Abstract

Background and aims

Acute myeloid leukemia (AML) prognosis is poor, with sustained remission occurring in <35% of young adults and <15% of older adults. This descriptive study examined the potential benefit of prolonged remission on the economic burden of AML.

Methods

Using the IBM MarketScan Commercial and Medicare Supplemental databases, we identified newly diagnosed patients with AML without hematopoietic stem cell transplantation from January 1, 2012 to December 31, 2018; AML diagnosis was the index date. Patients had 6 months of pre-index eligibility and were followed until the end of continuous eligibility, study data, or death. Active treatment and supportive care cohorts were defined; duration-of-remission subgroups (0 to <3, 3 to <6, 6 to <12, and ≥12 months) were established among active treatment patients with remission. Healthcare service utilization and costs were reported over follow-up and mutually exclusive treatment, remission, and post-relapse periods.

Results

This study included 1,558 active treatment and 1,127 supportive care patients who were followed for a median of 232 and 62 days, respectively. Over follow-up, active treatment and supportive care patients incurred mean ± standard deviation all-cause healthcare costs of $55,723 ± $61,994 and $68,596 ± $100,375 per-patient-per-month (PPPM), respectively. Decreasing PPPM costs were observed with increased remission duration (0 to <3 months: $71,823 ± $62,635; 3 to <6 months: $54,262 ± $44,734; 6 to <12 months: $35,287 ± $23,699; and ≥12 months: $15,615 ± $10,560). Although median follow-up varied by up to 5-fold, total costs were largely similar across duration-of-remission subgroups (0 to <3 months: $438,569 ± $332,675; 3 to <6 months: $590,411 ± $598,245; 6 to <12 months: $482,902 ± $369,115; and ≥12 months: $448,867 ± $316,133).

Conclusions

The economic burden of AML is substantial, even among untreated patients. Further, among patients with remission, longer durations in remission are associated with reduced PPPM healthcare costs, suggesting that remission-prolonging treatments could help mitigate healthcare costs.

Keywords:

• Acute myeloid leukemia
• burden of disease
• remission
• hematological cancer
• healthcare service utilization
• healthcare costs

JEL classification codes:

• I00
• I
• I11
• I1
• C55
• C5
• C

Transparency

Declaration of funding

This study was sponsored by Bristol Myers Squibb, Princeton, NJ.

Declaration of financial or other relationships

AT, DH, and KH are employees of Bristol Myers Squibb (BMS). BLB and KJ-P are employees of IBM Watson Health, which received funding from BMS for this study. RC reports employment and equity from BMS. TWL reports consultancy fees from AbbVie, Agios, Amgen, Astellas Pharma, AstraZeneca, BlueNote, BMS/Celgene, CareVive, Daiichi-Sankyo, FlatIron, GSK, Helsinn, Heron, Otsuka, Pfizer, Seattle Genetics, and Welvie; payment or honoraria for lectures and speakers’ bureaus from AbbVie, Agios, and BMS/Celgene; and grant/research funding from the American Cancer Society, BMS, CareVive, Duke University, Jazz Pharmaceuticals, the National Institute of Nursing Research/National Institutes of Health, and Seattle Genetics.

Peer reviewers on this manuscript have received an honorarium from JME for their review work. A reviewer on this manuscript has disclosed that they are employed by Johnson & Johnson. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

All authors contributed to the study design, interpretation of results, and manuscript preparation. All authors approved the final version for submission and are fully responsible for all content and editorial decisions for this manuscript.

Acknowledgements

The authors received editorial assistance in the preparation of this manuscript from Niamh Burke, PhD, of Excerpta Medica, funded by Bristol Myers Squibb.

Data availability statement

Bristol Myers Squibb policy on data sharing may be found at https://www.bms.com/researchers-and-partners/independent-research/data-sharing-request-process.html.

Ethical approval statement

This study was exempt from Institutional Review Board approval (anonymous administrative database study not requiring review).