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. 2019 Jul;8(8):3803-3810.
doi: 10.1002/cam4.2268. Epub 2019 May 29.

Treatment patterns, adverse events, and economic burden in a privately insured population of patients with chronic lymphocytic leukemia in the United States

Shaum M Kabadi  1 , Ravi K Goyal  2 , Saurabh P Nagar  2 , James A Kaye  3 , Keith L Davis  2
Affiliations

Treatment patterns, adverse events, and economic burden in a privately insured population of patients with chronic lymphocytic leukemia in the United States

Shaum M Kabadi et al. Cancer Med. 2019 Jul.

Abstract

Introduction: Contemporary data describing treatment patterns, adverse events (AEs), and outcomes in patients with chronic lymphocytic leukemia (CLL) in clinical practice are lacking. We conducted a retrospective cohort study and assessed treatment patterns, AEs, health-care resource use (HCRU), and costs in patients with diagnosis of CLL.

Methods: Using a nationally representative population of privately insured patients in the US, adult patients with CLL diagnosis (July 2012-June 2015) were selected if they had continuous health plan enrollment for ≥12 months before the first CLL diagnosis without any evidence of any CLL-directed treatment. Treatment patterns up to four lines of therapy (LOT) and occurrence of AEs during CLL therapies were assessed. Mean per-patient monthly HCRU and costs were assessed overall and by number of unique AEs.

Results: Of all patients meeting the selection criteria (n = 7,639; median age, 66 years), 18% (n = 1,379) received a systemic therapy during study follow-up. Of these, bendamustine/rituximab (BR) was the most common first observed regimen (28.1%), while ibrutinib was the most common therapy in the second (20.8%) and third (25.5%) observed regimens. The mean monthly all-cause and CLL-related costs, among patients treated with a systemic therapy, were $7,943 (SD = $15,757) and $5,185 (SD = $9,935), respectively. Mean monthly all-cause costs increased by the number of AEs (from $905 [SD = $1,865] among those with no AEs to $6,032 [SD = $13,290] among those with ≥6 AEs).

Conclusions: Chemoimmunotherapy, particularly BR, was the most common first observed therapy for CLL, whereas ibrutinib was most preferred in the second and third observed lines of therapy during the study period. Findings demonstrate that the economic burden of AEs in CLL is substantial.

Keywords: adverse events; chronic lymphocytic leukemia (CLL); economic burden; treatment patterns.

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Conflict of interest statement

Shaum M. Kabadi is a full‐time employee of AstraZeneca, the funding organization. Ravi K. Goyal, Saurabh P. Nagar, Keith L. Davis, and James A. Kaye are full‐time employees of RTI Health Solutions, which received funding from AstraZeneca to conduct this research.

Figures

Figure 1
Figure 1
Graphical summary of the study design. AE, adverse event; CLL, chronic lymphocytic leukemia; HCRU, health‐care resource use
Figure 2
Figure 2
All‐cause monthly health‐care costs by practice setting and number of AEs
See this image and copyright information in PMC

References

    1. American Cancer Society. Cancer facts & figures 2017 . 2017. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts.... Accessed May 10, 2018.
    1. Wierda WG, O'Brien S, Wang X, et al. Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia. Blood. 2007;109(11):4679‐4685. - PubMed
    1. Rozman C, Montserrat E. Chronic lymphocytic leukemia. N Engl J Med. 1995;333(16):1052‐1057. - PubMed
    1. Surveillance Epidemiology, End Results (SEER) . Cancer stat facts: Leukemia ‐ Chronic Lymphocytic Leukemia (CLL). https://seer.cancer.gov/statfacts/html/clyl.html. Accessed May 10, 2018.
    1. National Comprehensive Cancer Network (NCCN) . Clinical practice guidelines in oncology: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Version 2. 2017. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

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