Economic burden associated with adverse events of special interest in patients with relapsed Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia in the United States

Figures & data

Figure 1. Patient selection flowchart for adults with relapsed Ph− B-cell ALL.

Ph−: philadelphia chromosome-negative; ALL: acute lymphoblastic leukemia; ICD: International Classification of Diseases; DRG: diagnosis related group; Ph+: Philadelphia chromosome-positive.

Figure 2. Study period schema.

Table 1. Baseline characteristics of adult relapsed Ph− B-cell ALL patients with AESI.

Adult relapsed Ph− B-cell ALL patients with AESI	N = 370
Age, mean years (SD)	41.9 (17.0)
Sex, n (%)
Male	233 (63.0%)
Female	137 (37%)
Health plan type, n (%)
Comprehensive/indemnity	16 (4.3%)
Preferred/Exclusive Provider Organization	221 (59.7%)
Health Maintenance Organization	53 (14.3%)
Point of service with or without capitation	19 (5.1%)
Other^a/Unknown	61 (16.5%)
Geographic region, n (%)
Northeast	76 (20.5%)
North Central	62 (16.8%)
South	140 (37.8%)
West	84 (22.7%)
Unknown	8 (2.2%)
Deyo-Charlson Comorbidity Index, mean (SD)	3.0 (2.2)
HSCT transplant, n (%)	104 (28.1%)
Length of follow-up, mean days (SD, median)	83.7 (28.3, 100)

^aOther insurance plan types included consumer-driven health plans (CDHP) and high-deductible health plans (HDHP).

AESI Adverse events of special interest, HSCT Hematopoietic stem cell transplant.

Figure 3. AESI frequency by event type.

*AESI: adverse events of special interest; GI: gastrointestinal.

Table 2. Total, inpatient, and outpatient costs of AESI by event type during follow-up.

AESI event type		Patients, N (%)	Total costs, mean (SD)	Median	Inpatient costs, mean (SD)	Median	Outpatient costs, mean (SD)	Median
All AESI		370 (100%)	$197,213 ($308,551)	$105,731	$185,990 ($306,448)	$90,640	$11,223 ($33,716)	$2760
Infection		239 (64.6%)	$164,461 ($347,083)	$64,528	$160,091 ($345,593)	$54,557	$4370 ($35,388)	0
Bacteremia		80 (21.6%)	$13,737 ($73,442)	$1331	$13,019 ($73,540)	$858	$718 ($1834)	0
Febrile neutropenia		79 (21.4%)	$33,437 ($80,003)	$4261	$33,189 ($80,043)	$3819	$248 ($1183)	0
Line infections		28 (7.6%)	$26,483 ($85,786)	$1418	$26,355 ($85,824)	$1397	$128 ($591)	0
Pneumonia		101 (27.3%)	$57,569 ($122,368)	$1936	$56,635 ($122,526)	$1635	$935 ($4273)	0
Sepsis		148 (40.0%)	$204,151 ($412,572)	$79,853	$198,244 ($411,017)	$75,115	$5907 ($44,409)	0
Cytopenia		350 (94.6%)	$125,210 ($165,141)	$67,475	$115,659 ($161,269)	$59,084	$9551 ($23,440)	$1928
Anemia		233 (63.0%)	$40,604 ($93,413)	$8881	$35,245 ($92,370)	$1775	$5359 ($11,177)	$826
Neutropenia		253 (68.4%)	$43,691 ($106,747)	$5620	$40,268 ($106,426)	$2548	$3423 ($13,543)	$295
Thrombocytopenia		211 (57.0%)	$39,577 ($94,084)	$10,178	$34,888 ($93,907)	$1695	$4689 ($9638)	$799
Other cytopenia		228 (61.6%)	$98,900 ($143,961)	$39,777	$93,586 ($139,531)	$32,674	$5314 ($23,623)	$11
GI toxicity		171 (46.2%)	$11,652 ($40,231)	$1349	$10,420 ($39,632)	$675	$1232 ($3355)	$0
Nausea/vomiting		99 (26.8%)	$6829 ($21,230)	$1286	$5383 ($21,004)	$429	$1446 ($3623)	$108
Diarrhea		54 (14.6%)	$2042 ($4055)	$792	$1812 ($3877)	$529	$230 ($630)	$0
Gastritis/duodenitis		22 (6.0%)	$1375 ($1651)	$929	$554 ($643)	$195	$820 ($1803)	$0
GI bleeding		23 (6.2%)	$29,161 ($70,561)	$707	$28,487 ($70,731)	$303	$674 ($1616)	$0
Mucositis/Stomatitis		59 (16.0%)	$8868 ($37,934)	$762	$8355 ($37,938)	$379	$512 ($2900)	$0

AESI, adverse events of special interest; GI, gastrointestinal.

Table 3. Plan-paid inpatient and outpatient costs of AESI by event type during follow-up.

AESI event type		Total plan-paid costs, mean (SD)	Median	Plan-paid inpatient costs, mean (SD)	Median	Plan-paid outpatient costs, mean (SD)	Median
All AESI		$196,662 ($308,588)	$105,353	$185,534 ($306,487)	$90,217	$11,127 ($33,665)	$2676
Infection		$164,164 ($347,123)	$57,610	$159,803 ($345,629)	$53,390	$4361 ($35,371)	$0
Bacteremia		$13,707 ($73,447)	$1331	$13,000 ($73,543)	$855	$707 ($1820)	$0
Febrile neutropenia		$33,005 ($79,867)	$4246	$32,757 ($79,906)	$3819	$247 ($1183)	$0
Line infections		$26,436 ($85,649)	$1404	$26,308 ($85,687)	$1332	$128 ($591)	$0
Pneumonia		$57,454 ($122,312)	$1914	$56,525 ($122,467)	$1560	$929 ($4271)	$0
Sepsis		$203,946 ($412,595)	$79,853	$198,043 ($411,037)	$75,115	$5903 ($44,391)	$0
Cytopenia		$124,746 ($165,091)	$66,820	$115,286 ($161,249)	$58,170	$9460 ($23,381)	$1853
Anemia		$40,262 ($93,264)	$8881	$34,959 ($92,262)	$1643	$5303 ($11,096)	$763
Neutropenia		$43,419 ($106,692)	$5620	$40,015 ($106,371)	$2467	$3404 ($13,522)	$276
Thrombocytopenia		$39,355 ($94,037)	$9696	$34,730 ($93,874)	$1637	$4624 ($9553)	$709
Other cytopenia		$98,684 ($143,947)	$39,756	$93,415 ($139,538)	$32,278	$5269 ($23,589)	$7
GI toxicity)		$11,550 ($40,159)	$1347	$10,330 ($39,563)	$649	$1221 ($3351)	$0
Nausea/vomiting		$6774 ($21,217)	$1242	$5341 ($20,992)	$429	$1433 ($3620)	$83
Diarrhea		$2007 ($4049)	$610	$1777 ($3870)	$480	$230 ($630)	$0
Gastritis/duodenitis		$1342 ($1666)	$929	$522 ($638)	$192	$820 ($1803)	$0
GI bleeding		$29,027 ($70,276)	$707	$28,362 ($70,461)	$303	$666 ($1616)	$0
Mucositis/stomatitis		$8755 ($37,939)	$665	$8251 ($37,939)	$364	$504 ($2895)	$0

AESI, adverse events of special interest; GI, gastrointestinal.