Results from a retrospective study comparing patients with chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), and non-Hodgkin lymphoma (NHL) with and without disease progression showed that delaying disease progression was associated with substantial reductions in health care costs. This study was published online in the Oncologist.
While many studies of the impact of health care policies on the cost effectiveness of cancer care have focused on patients with solid tumors, this topic has been less well investigated in the setting of hematologic malignancies. Furthermore, the blood cancers umbrella covers a diverse group of malignancies with respect to disease severity and therapeutic approaches.
This retrospective study used administrative claims data from the Optum Research Database, which includes enrollment information and medical and pharmacy claims for millions of patients with either commercial insurance coverage or Medicare Advantage with Part D coverage.
The main aim of the study was to estimate the incremental cost of disease progression (defined as receiving second-line therapy, hospice care, or death) over a 12-month period in adult patients (aged at least 18 years) with CLL, AML, and NHL during the period of July 2007 through August 2014.
The date of the receipt of the first cancer medication was defined as the index date, the 6-month period prior to the index date was defined as the baseline period, and the period after the index date to death, treatment discontinuation, or end of the study (whichever came first) was defined as the follow-up period. Only patients with baseline data were included in the study, and outcomes (ie, disease progression and health care costs) were measured only for those with 12 months of follow-up data (unless death occurred first).
Of the patients with 12-month follow-up data, disease progression occurred in 31.1% (328/1056) of patients with CLL, in 63.8% (328/514) of patients with AML, and in 36.9% (2802/7601) of patients with NHL.
Following adjustments for demographics, pretreatment comorbidity, baseline health care costs, and whether patients received radiation therapy during the baseline period, patients with CLL, AML, and NHL experiencing disease progression had health care costs that were 34.5% higher (P <.001), 4.7% (P =.572), and 41.1% higher (P <.001), respectively, compared with corresponding patients without disease progression.
“New treatments that delay disease progression in patients with hematologic cancer could have a significant impact on the economic burden of hematologic malignancies,” the authors concluded.
- Reyes C, Engel-Nitz NM, DaCosta Byfield S, et al. Cost of disease progression in patients with chronic lymphocytic leukemia, acute myeloid leukemia, and non-Hodgkin’s lymphoma [published online February 26, 2019]. Oncologist. doi: 10.1634/theoncologist.2018-0019