Cost of Disease Progression in Patients with Chronic Lymphocytic Leukemia, Acute Myeloid Leukemia, and Non-Hodgkin's Lymphoma

Abstract

Introduction: To reduce health care costs and improve care, payers and physician groups are switching to quality-based and episodic or bundled-care models. Disease progression and associated costs may affect these models, particularly if such programs do not account for differences in disease severity and progression risk within the cohort. This study estimated the incremental cost of disease progression in patients diagnosed with chronic lymphoid leukemia (CLL), acute myeloid leukemia (AML), and non-Hodgkin's lymphoma (NHL) and compared costs among patients with and without progression.

Methods: This was a retrospective study using U.S. administrative claims data from commercial and Medicare Advantage health care enrollees with evidence of CLL, AML, and NHL and systemic antineoplastic agent use from July 1, 2006 to August 31, 2014. Outcome measures included disease progression, 12-month health care costs, and 3-year cumulative predictive health care costs.

Results: Of 1,056 patients with CLL, 514 patients with AML, and 7,601 patients with NHL, 31.1% of patients with CLL, 63.8% of those with AML, and 36.9% of those with NHL had evidence of disease progression. Among patients with CLL and NHL, adjusted and unadjusted health care costs were significantly higher among progressors versus nonprogressors. Per-patient-per-month costs, accounting for variable follow-up time, were almost twice as high among progressors versus nonprogressors in patients with CLL, AML, and NHL. In each of the three cancer types, the longer disease progression was delayed, the lower the health care costs.

Conclusion: Progression of CLL, AML, and NHL was associated with higher health care costs over a 12-month period. Delaying cancer progression resulted in a substantial cost reduction in patients with all three cancer types.

Implications for practice: Data on the rates and incremental health care costs of disease progression in patients with hematologic malignancies are lacking. This study estimated the incremental costs of disease progression in patients diagnosed with chronic lymphocytic leukemia, acute myeloid leukemia, and non-Hodgkin's lymphoma and compared health care costs in patients with and without evidence of disease progression in a real-world population. The data obtained in this study will assist future studies in quantifying the cost impact of decreased progression rates and will inform payers and physician groups about setting rates for episode and bundled payment programs.

Keywords: Acute myeloid leukemia; Chronic lymphocytic leukemia; Costs; Non‐Hodgkin's lymphoma; Progression.

Figure 1.

Patient selection. Abbreviations: ACST, anticancer systemic therapy; AML, acute myeloid leukemia; CLL, chronic lymphocytic leukemia; ICD‐9, International Classification of Diseases, 9th Revision; NHL, non‐Hodgkin's leukemia.

Figure 2.

Unadjusted 12‐month health care costs among patients with CLL, AML, and NHL by site of service. Notes: a, Multiple types of NHL are categories first as aggressive, then indolent, then unknown; unknown (n = 4,995) and uncategorized (n = 793) categories are not shown; b, Pharmacy costs include costs for outpatient pharmacy fills. Abbreviations: AML, acute myeloid leukemia; CLL, chronic lymphocytic leukemia; ER, emergency room; NHL, non‐Hodgkin's leukemia; PD, disease progression.

Figure 3.

Adjusted 12‐month health care costs among patients with CLL, AML, and NHL. Abbreviations: AML, acute myeloid leukemia; CLL, chronic lymphocytic leukemia; CI, confidence interval; NHL, non‐Hodgkin's leukemia.

Figure 4.

Cumulative predictive costs of chronic lymphocytic leukemia based on month of progression. Costs in progressed patients (red bar) represent a range of costs depending on whether patients progressed in the first through last month of the corresponding time period.

Figure 5.

Cumulative predictive costs of acute myeloid leukemia based on month of progression. Costs in progressed patients (red bar) represent a range of costs depending on whether patients progressed in the first through last month of the corresponding time period.

Figure 6.

Cumulative predictive costs of non‐Hodgkin's lymphoma based on month of progression. Costs in progressed patients (red bar) represent a range of costs depending on whether patients progressed in the first through last month of the corresponding time period.