EC3 Economic Burden of Cardiovascular Events in Patients with Chronic Lymphocytic Leukemia Treated with Novel Agents

Abstract

Novel agent treatments (NATs) have improved survival in chronic lymphocytic leukemia (CLL), but can be associated with increased cardiovascular (CV) events. This analysis examined real-world healthcare costs associated with CV events in CLL patients treated with NATs. Using US-commercial administrative claims data (IBM MarketScan), we compared unadjusted healthcare costs among CLL patients taking NATs with and without a CV event during treatment (CV vs. noCV). Inclusion criteria were adult CLL patients, evidence of NATs (acalabrutinib, duvelisib, ibrutinib, idelalisib, venetoclax) between November 2013-November 2019 (index date=earliest fill date), continuous enrollment for 6-months pre-index (baseline), and no evidence of NATs or trial participation during baseline. Annual all-cause and CV-related healthcare costs (adjusted to 2019 US dollars) were measured in a fixed 12-month follow-up period while per-patient-per-month (PPPM) costs were compared in variable-length pre/post-CV event periods. Of 1,886 CLL patients with NATs, 27.7% experienced a CV event during treatment, occurring a mean(SD) 103.0(93.9) days following NAT initiation. Almost half (47.1%) of CV patients had a CV event pre-index, the majority of which were hypertension. CV patients were older (71.7 vs. 65.8, p<0.001) and had a higher baseline NCI score (1.2 vs. 0.8, p<0.001) than noCV patients. Annual all-cause total healthcare costs were higher in the CV vs. noCV cohort ($203,349 vs. $165,144, p<0.001). Higher annual medical costs ($82,949 vs. $45,293, p<0.001) compensated for numerically lower NAT costs in CV vs. noCV cohort ($110,925 vs. $115,026, p=0.262). Pre-CV event, outpatient pharmacy PPPM costs contributed most to total healthcare costs; post-CV event, PPPM medical costs contributed more: outpatient pharmacy 74.8% vs. 38.8%, hospitalization 7.6% vs. 38.8%, and outpatient services 17.7% vs. 22.4%. In CLL patients with a CV event, higher medical costs compensate for decreased novel agent costs, suggesting increased medical management in addition to NAT discontinuation.