Cost of chronic lymphocytic leukemia (CLL) in Medicare patients

Abstract

17531 Background: About 15,000 new cases of CLL are diagnosed annually in the United States but the direct medical costs attributable to CLL have not been delineated. Methods: We analyzed the CLL cost of care using SEER-Medicare data. Patients with CLL (including small lymphocytic lymphoma) as their first primary cancer were diagnosed from 1998–2002 with follow up through 2005. Patients had to have ≥ 1 year of prior non-HMO Medicare coverage. Costs were taken from claims for inpatient, outpatient and physician services. Control comparisons were made both to the pre-diagnosis 12 month period and to a 5% sample of Medicare patients without a cancer diagnosis. Linear regression models with robust standard errors were adjusted for age, co-morbidity score, diagnosis year, gender, and county of residence. Results: There were 3,999 patients who met the inclusion criteria. The median time from diagnosis to first chemotherapy was 199 days. The unadjusted mean monthly cost was similar regardless of control groups (∼$2,700). This cost declined over time but did not reach the pre-diagnosis level. Most costs were for inpatient and provider charges with chemotherapy representing 6.9% of 1st year and 8–10% of later year costs. After adjustment the incremental cost of CLL was $2,773/month for the first year compared to the 5% Medicare sample (p<0.05). Increasing age, male gender, and non-white race were significantly associated with increased monthly costs (p<0.01) Conclusions: CLL is associated with increased costs of care in the Medicare population, particularly in the first year after diagnosis where it is over $33,000 per patient. Mean monthly cost ($) relative to diagnosis date Health Service 12 Months Before 12 Months After 12–24 Months After 24–36 Months After Medicare 5% Sample Inpatient facility 287 2244 1038 1005 227 Provider 172 901 573 753 133 Outpatient facility 11 25 20 23 5 Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Genentech Genentech Genentech