AML-157: Economic Burden of Hospitalizations for Acute Myeloid Leukemia (AML) in Remission in the United States: A Retrospective Analysis of an Administrative Claims Database

Abstract

<h3>Context:</h3> Healthcare resource utilization and costs of managing AML patients are substantial, with hospitalization being the main cost driver of AML care. In the Phase 3 QUAZAR AML-001 maintenance trial, lower rates and durations of hospitalization with oral azacitidine <i>vs</i> placebo corresponded with substantial reductions in hospitalization-related costs in patients with AML in remission. <h3>Objective:</h3> Examine the impact of remission duration on the economic burden of hospitalizations among AML patients in a real-world setting. <h3>Methods:</h3> Adult patients with an AML diagnosis (ICD-9-CM/ICD-10-CM) who achieved remission after first-line induction chemotherapy were identified from an administrative claims health database (Optum® Clinformatics® Data Mart). Additional inclusion/exclusion criteria were applied to match the QUAZAR AML-001 trial population. Eligible patients were organized into cohorts based on their duration of remission (DOR): cohort A < median DOR, cohort B ≥ median DOR. Hospitalization incidence and duration were analyzed between cohorts using an appropriate count model for hospitalizations. Hospitalization-related costs were compared using a generalized linear model with gamma distribution and log-link function. <h3>Results:</h3> Overall, median DOR was 125 days; cohorts A and B included 220 and 231 patients, respectively, with median times from remission to end of follow-up of 89 and 378 days. Baseline characteristics were comparable between cohorts (mean [SD] age 62.8 [14.7] years, Charlson comorbidity index [CCI] 1.7 [1.6]) except for sex (male: 59.5% <i>vs</i> 47.6%). The number of hospitalizations (4.71 <i>vs</i> 2.68 per patient per year [PPPY]) and total length of stays (43.88 <i>vs</i> 23.59 days PPPY) were higher in cohort A <i>vs</i> B, respectively; estimated hospitalization-related costs (2019 USD) were $242,511 <i>vs</i> $132,554 PPPY, respectively. Cumulative mean hospitalization cost per patient was $61,371 higher in Cohort A at 12 months and $108,593 higher at 24 months. When adjusted for confounding baseline variables (e.g., age, sex, CCI), the number, length, and cost of hospitalization were each significantly greater in cohort A than in cohort B (P<0.001 each). <h3>Conclusions:</h3> In a real-world setting, prolonged remission was associated with significantly lower rates and durations of hospitalization in patients with AML in remission following induction chemotherapy, which were estimated to result in substantial cumulative cost savings.