Results of a retrospective cohort analysis of privately insured patients with a diagnosis of chronic lymphocytic leukemia (CLL) showed an over 6-fold increase in mean per-patient monthly health care costs when patients with no treatment-related adverse events were compared with those experiencing 6 or more adverse events of treatment. The findings from this study were published in Cancer Medicine.

In this retrospective cohort study, the IBM MarketScan Research Databases, which include health care claims data for a large number of individuals insured through employee-sponsored private plans across the US, were interrogated regarding patient- and treatment-related characteristics, as well as CLL-related and all-cause utilization of health care resources for adult patients with a medical claim including a diagnosis with CLL or small lymphocytic leukemia (SLL) between July 1, 2012, and June 30, 2015.

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All patients included in the study had been enrolled in medical and drug plans for at least 12 consecutive months prior to the study index date representing CLL diagnosis, and had no evidence of CLL during that period. All patients were followed until June 2016 or disenrollment in the insurance plan, whichever came first.

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With a focus on systemic therapies, information on treatment regimens, including their compositions and relative times of initiation, was collected for up to 4 lines of therapy, and identified as line of treatment (LOT)-1, 2, 3, and 4 since limitations of the 12-month baseline period precluded definitive identification of treatment regimens as frontline versus subsequent therapy. In addition, the total number of unique adverse events recorded during the follow‐up period, as well as mean monthly health care resource utilization and associated costs were assessed for each patient.

Key findings of this study included a mean Charleston Comorbidity Index score of 2.1 during the baseline period, with infection (49%), and hypertension (40%) as the most common comorbidities. During the baseline period, the mean monthly all-cause cost was $962.

Regarding CLL-related treatment, only 29% of patients received systemic therapy during the study, which had a median follow-up of 20.6 months. In that subgroup of patients, bendamustine/rituximab (28.1%) was the most common LOT-1, while treatment with the Bruton tyrosine kinase inhibitor, ibrutinib, was most common in LOT-2 (20.8%), and LOT-3 (25.5%). Overall, only 1.6% of patients received treatment with the phosphatidylinositol 3‐kinase inhibitor, idelalisib, although patients were more likely to receive this treatment in later lines of therapy.

With respect to treatment toxicity, neutropenia, nausea/vomiting, dehydration, and fever/pyrexia were more common in patients receiving rituximab-based chemoimmunotherapy compared with ibrutinib monotherapy, whereas rates of atrial fibrillation, hemorrhage/bleeding, and hypertension were highest in those receiving single-agent ibrutinib compared with chemoimmunotherapy regimens.

During the post-index date follow-up period for all study patients, the mean costs per month per patient for all-cause and CLL-related events were $3784 and $1885, respectively. When only the subgroup of patients receiving systemic therapy was considered, these costs increased to $7943 and $5185 for all-cause and CLL-related events. The mean monthly costs during treatment for patients treated with bendamustine/rituximab were $14,640, and $21,766 for those receiving single-agent ibrutinib. 

Of note, mean all-cause costs per month per patient during the post‐index follow‐up period were $905, $1655, $2883, and $6032 for those patients experiencing 0, 1 to 2, 3 to 5, and 6 or more treatment-related adverse events.

In summarizing the study findings, the authors noted that “this study shows that the adverse event burden associated with current treatments for CLL is substantial, and the management of adverse events occurring during treatments may have a significant impact on overall healthcare costs.”

Disclosure: One of the study authors (SK) is a full-time employee of AstraZeneca, Inc, the funding organization for this study.


Kabadi SM, Goyal RK, Nagar SP, et al. Treatment patterns, adverse events, an economic burden in a privately insured population of patients with chronic lymphocytic leukemia in the United States. Cancer Med. doi: 10.1002/cam4.2268