Economic benefits of adequate molecular monitoring in patients with chronic myelogenous leukemia

Abstract

Objective:

Molecular monitoring of chronic myeloid leukemia (CML) has been associated with improved clinical outcomes during tyrosine kinase inhibitor therapy (TKI), yet recent studies have demonstrated its use is far below published guidelines. This study sought to determine frequencies of molecular monitoring and its impact on resource utilization and medical costs.

Methods:

A retrospective US claims administrative database (IMS LifeLink Health Plan Claims and Truven Health Analytics MarketScan databases, 11/2007–06/2012) was used to analyze the economic impact of qPCR testing in CML patients on first-line TKIs during the initial 12-months of treatment.

Results:

One thousand two hundred and five adult CML patients met the sample selection criteria. Among these, 41.0% had no qPCR tests, 31.9% had 1–2 tests, and 27.1% had 3–4 tests; 88.9% were initiated on imatinib; 47.7% were female. Patients in the 3–4 tests cohort incurred 44% (p < 0.001) fewer in-patient (IP) admissions than patients in the 0-tests cohort. Adjusted all-cause IP cost was $5663 (p = 0.005) lower for the 3–4 tests cohort than the 0-tests cohort. Adjusted progression-related IP cost was $4132 (p = 0.013) lower for the 3–4 tests cohort than the 0-tests cohort. Adjusted medical service cost was $5997 (p = 0.049) lower for the 3–4 tests cohort than the 0-tests cohort.

Limitations:

Claims databases did not include information on the primary cause of hospitalizations.

Conclusions:

Among CML patients in two large claims databases, nearly three-quarters did not receive adequate molecular monitoring per published guidelines. Those who were more frequently monitored incurred lower medical service costs, with the majority of the difference in costs being related to disease progression. These findings underscore the clinical and economic values of molecular monitoring in CML.

Keywords::

• Chronic myelogenous leukemia
• Quantitative real time polymerase chain reaction
• Resource utilization
• Costs
• Progression
• Tyrosine kinase inhibitor

Transparency

Declaration of funding

This study was sponsored by Novartis Pharmaceuticals Corporation.

Declaration of financial/other relationships

AG, KD, and EQW are employees of Analysis Group, Inc., which has received consultancy fees from Novartis Pharmaceuticals Corporation. LC is an employee of Novartis Pharmaceuticals Corporation. SLG receives research funding from Ariad Pharmaceuticals, Bristol Myers Squibb, and Novartis Oncology.

Acknowledgments

We thank Ana Bozas, an employee of Analysis Group Inc., who contributed to the preparation and editing of the manuscript, funded by Novartis Pharmaceuticals Corporation.

Previous presentation

This study was presented at the 2013 ASCO Annual Meeting, Chicago, Illinois, May 31–June 4, 2013.