Work absenteeism, disability, and lost wages among patients with acute myeloid leukemia and their caregivers: a cohort study using US administrative claims and productivity data

Figures & data

Figure 1. Study design. AML, acute myeloid leukemia; HSCT, hematopoietic stem cell transplant.

Figure 2. (Continued).

Figure 2. Flowchart of (a) patients with AML and (b) caregivers of patients with AML, who were evaluated and met the inclusion criteria for the study. AML, acute myeloid leukemia; HPM, Health and Productivity Management (Database); LTD, long-term disability; STD, short-term disability.

Table 1. Baseline demographics and characteristics for (a) patients with AML and (b) caregivers of patients with AML.

(a)
Characteristic	Patients, N = 1,037
Mean (SD) age, years	49.8 (9.8)
Median	52.0
Sex, n (%)
Male	731 (70.5)
Female	306 (29.5)
Geographic region, n (%)
Northeast	204 (19.7)
North Central	232 (22.4)
South	392 (37.8)
West	208 (20.1)
Unknown	1 (0.1)
Urbanicity, n (%)
Urban	946 (91.2)
Rural	90 (8.7)
Unknown	1 (0.1)
Insurance plan type, n (%)
EPO/PPO	572 (55.2)
CDHP/HDHP	282 (27.2)
HMO	90 (8.7)
Other^a	93 (9.0)
Family insurance coverage, n (%)
Spouse covered under same health plan	693 (66.8)
Dependent covered under same health plan	562 (54.2)
Duration of follow-up, days
Mean (SD); median	546.2 (388.0); 455.0
Category, n (%)
≥6 months	583 (56.2)
≥12 months	354 (34.1)
≥24 months	242 (23.3)
Reason for end of follow-up, n (%)
End of HPM eligibility	182 (17.6)
End of continuous enrollment	486 (46.9)
End of study period	127 (12.3)
Reached maximum 3 years of follow-up	242 (23.3)
(b)
Characteristic	Caregivers, N = 781
Mean (SD) age, years	50.9 (7.9)
Median	52.0
Sex, n (%)
Male	545 (69.8)
Female	236 (30.2)
Geographic region, n (%)
Northeast	139 (17.8)
North Central	193 (24.7)
South	276 (35.3)
West	172 (22.0)
Unknown	1 (0.1)
Urbanicity, n (%)
Urban	720 (92.2)
Rural	60 (7.7)
Unknown	1 (0.1)
Insurance plan type, n (%)
EPO/PPO	467 (59.8)
CDHP/HDHP	172 (22.0)
HMO	63 (8.1)
Other^a	79 (10.1)
Family insurance coverage, n (%)
Spouse covered under same health plan	759 (97.2)
Dependent covered under same health plan	600 (76.8)
Duration of follow-up, days
Mean (SD); median	781.4 (358.6); 967.0
Category, n (%)
≥6 months	629 (80.5)
≥12 months	464 (59.4)
≥24 months	342 (43.8)
Reason for end of follow-up, n (%)
End of HPM eligibility	96 (12.3)
End of continuous enrollment	200 (25.6)
End of study period	143 (18.3)
Reached maximum 3 years of follow-up	342 (43.8)

^aOther included comprehensive/indemnity, point of service/point of service with capitation, other, and unknown.

AML, acute myeloid leukemia; CDHP, consumer-driven health plan; EPO, exclusive provider organization; HDHP, high deductible health plan; HMO, health maintenance organization; HPM, Health and Productivity Management (Database); PPO, preferred provider organization; SD, standard deviation.

Table 2. Baseline comorbid conditions recorded for patients with AML.

Characteristic	Patients, N = 1,037
NCI modification of CCI, mean (SD)	0.22 (0.35)
No. comorbid conditions, mean (SD); median	2.6 (2.1); 2.0
Comorbid condition or symptoms of interest, n (%)
Any malignancy^a	485 (46.8)
Metastatic solid tumor	55 (5.3)
AIDS/HIV	8 (0.8)
Anemia	397 (38.3)
Anxiety	110 (10.6)
Cerebrovascular disease	42 (4.1)
Stroke	19 (1.8)
Chronic pulmonary disease	68 (6.6)
Congestive heart failure	35 (3.4)
Dementia	1 (0.1)
Depression	86 (8.3)
Diabetes	224 (21.6)
Fatigue	231 (22.3)
Gastrointestinal ulcer	115 (11.1)
Hemiplegia or paraplegia	6 (0.6)
Hypertension	375 (36.2)
Insomnia	36 (3.5)
Liver disease	88 (8.5)
Myocardial infarction	11 (1.1)
Nausea/vomiting	114 (11.0)
Peptic ulcer disease	3 (0.3)
Peripheral vascular disease	33 (3.2)
Post-traumatic stress disorder	3 (0.3)
Renal disease	169 (16.3)
Substance abuse	18 (1.7)

^aIncluding lymphoma and leukemia, except malignant neoplasm of skin.

AIDS, acquired immune deficiency syndrome; AML, acute myeloid leukemia; CCI, Charlson Comorbidity Index; HIV, human immunodeficiency virus; NCI, National Cancer Institute; SD, standard deviation.

Table 3. AML-related health-care resource use and clinical characteristics^a recorded for patients with newly diagnosed AML.

	Patients, N = 1,037
AML characteristic	Baseline period	Follow-up period
All-cause inpatient admission, n (%)	265 (25.6)	745 (71.8)
Length of stay, mean (SD), days	8.0 (6.9)	16.5 (12.8)
Days to first inpatient admission, mean (SD)	-	34.8 (116.0)
AML-related inpatient admission, n (%)	-	473 (45.6)
Length of stay, mean (SD), days	-	27.9 (17.3)
Days to first inpatient admission, mean (SD)	-	45.1 (112.7)
Relapsed AML, n (%)	-	152 (14.7)
Days to first relapse, mean (SD)	-	193.6 (193.8)
AML in remission, n (%)	-	384 (37.0)
Days to first remission, mean (SD)	-	117.2 (167.1)
HSCT, n (%)	-	238 (23.0)
Days to first HSCT, mean (SD)	-	132.8 (174.2)
FLT3 inhibitor, n (%)	-	34 (3.3)
Gilteritinib	-	5 (0.5)
Midostaurin	-	21 (2.0)
Sorafenib	-	16 (1.5)
Intensity of antineoplastic chemotherapy, n(%)
High intensity^b	-	462 (44.6)
Low intensity^c	-	35 (3.4)
ICU admission, n (%)	-	434 (41.9)
AML-related ICU admission	-	220 (21.2)
Leukapheresis, n (%)	-	10 (1.0)

^aHealth-care resource use and clinical characteristics were identified by ≥ 1 non-diagnostic medical claim with a diagnosis for the condition during the baseline or variable length follow-up period; ^bDefined as an inpatient admission for acute leukemia or a medical or pharmacy claim with one of the following agents within −7 to +14 days of the index date: 1) cytarabine and one of cladribine, daunorubicin, doxorubicin, etoposide, idarubicin, mitoxantrone; or 2) cladribine and clofarabine; ^cMedical or pharmacy claim for 5-azacitidine, subcutaneous cytarabine, decitabine, enasidenib, gemtuzumab, glasdegib, ivosidenib, or venetoclax.

AML, acute myeloid leukemia; HSCT, hematopoietic stem cell transplant; SD, standard deviation.

Figure 3. Mean monthly AML workplace loss by work loss type for (a) patients with AML and (b) caregivers. AML, acute myeloid leukemia; HSCT, hematopoietic stem cell transplant.

Table 4. Work loss and associated indirect costs incurred during baseline and full follow-up period for (a) AML patients and (b) caregivers of AML patients.

(a)
	Patients, N = 1,037		p-value
Characteristic	Baseline period^a	Follow-up period^b
Total no. individuals with absence eligibility, n (%)	158 (15.2)	158 (15.2)	-
No. with any workplace absence during observation period, n (%)	115 (72.8)	99 (62.7)	0.054
Days lost due to workplace absence PPPM, mean (SD)	2.2 (2.0)	2.1 (3.4)	0.735
Indirect costs associated with workplace absence PPPM, mean (SD)	$562 (501)	$511 (836)	0.516
Total no. individuals with STD eligibility, n (%)	1000 (96.4)	1000 (96.4)	-
No. with STD claim during observation period, n (%)	246 (24.6)	500 (50.0)	<0.001
Days lost due to STD PPPM, mean (SD)	0.9 (2.5)	4.9 (6.9)	<0.001
Indirect costs associated with STD PPPM, mean (SD)	$203 (600)	$1194 (1709)	<0.001
Total no. individuals with LTD eligibility, n (%)	759 (73.2)	759 (73.2)	-
No. with LTD claim during observation period, n (%)	30 (4.0)	152 (20.0)	<0.001
Days lost due to LTD PPPM, mean (SD)	0.2 (1.9)	1.4 (4.2)	<0.001
Indirect costs associated with LTD PPPM, mean (SD)	$57 (456)	$330 (992)	<0.001
(b)
	Caregivers, N = 781
Characteristic	Baseline period^a	Follow-up period^b	p-value
Total no, individuals with absence eligibility, n (%)	137 (17.5)	137 (17.5)	-
No. with any workplace absence during observation period, n (%)	114 (83.2)	115 (83.9)	0.871
Days lost due to workplace absence PPPM, mean (SD)	2.4 (1.8)	2.6 (2.0)	0.315
Indirect costs associated with workplace absence PPPM, mean (SD)	$619 (455)	$673 (506)	0.354
Total no. individuals with STD eligibility, n (%)	748 (95.8)	748 (95.8)	-
No. with STD claim during observation period, n (%)	40 (5.4)	88 (11.8)	<0.001
Days lost due to STD PPPM, mean (SD)	0.2 (0.9)	0.3 (1.1)	0.057
Indirect costs associated with STD PPPM, mean (SD)	$38 (231)	$60 (268)	0.087
Total no. individuals with LTD eligibility, n (%)	569 (72.9)	569 (72.9)	-
No. with LTD claim during observation period, n (%)	2 (0.4)	4 (0.7)	0.687
Days lost due to LTD PPPM, mean (SD)	<0.1 (0.2)	<0.1 (0.2)	0.936
Indirect costs associated with LTD PPPM, mean (SD)	$2 (44)	$2 (39)	0.986

AML, acute myeloid leukemia; LTD, long-term disability; PPPM, per person per month; SD, standard deviation; STD, short-term disability.

^aBaseline period: 12-month time period prior to index date; ^bFull follow-up period: Time period after index date up until a censoring event ending follow-up.