Health care utilization and costs in patients with early onset myelodysplastic syndrome in a commercially insured population.

Abstract

6552 Background: Myelodysplastic syndrome (MDS) affects about 1 in 10,000 individuals. After diagnosis, patients are treated with hypomethylating agents (HMA) and thalidomide analogues (TA) or receive best supportive care. Methods: This analysis describes the health care services utilized and the cost of these services among commercially insured patients aged ≥ 65 years old and newly diagnosed with MDS. This was a descriptive cohort study using medical and pharmacy claims from a large US insurer. The data were deidentified and HIPAA compliant. The study included patients who were ≥ 65 years old, had an initial MDS claim (ICD-9-CM 238.72-283.75) from 2/1/2007 to 7/31/2008, and were continuously enrolled for 6 months prior to and 12 months following the index claim. Baseline demographic variables were calculated in pre-index claims. Utilization and costs were calculated post-index. Patient demographic data were also reported. Results: A total of 578 patients were identified, all diagnosed with MDS, ≥ 65 years old and continuously enrolled in the health plan. Of these, 40% were 65-74, 47% aged 75-84, and 13% ≥ 85. Women made up 44% of the sample. In the first year after diagnosis, 93% (n=536) received best supportive care only and 7% (n=42) were treated with medication. Treatment consisted of HMA in 33 patients and TA in 9. In treated patients, a mean of 94.6 days (SD 94, Md 60) elapsed from diagnosis to HMA or TA treatment. Patients had a mean of 27.6 office visits (SD 19.7, Md 23) in the year after diagnosis. At least one hospitalization occurred in 51% of patients (n=296) and 17% were hospitalized 3 or more times. Mean length of stay among those hospitalized was 14 days. Mean total healthcare charges were $84,628 (SD 115,028, Md $46,816). Conclusions: In this study, few patients aged ≥ 65 and newly diagnosed MDS were treated with HMA or TA in the first year after diagnosis, despite the fact that the HMAs have been shown to lead to improvement in clinical and economic outcomes and are recommended in the NCCN guidelines. MDS was associated with frequent hospitalizations and outpatient visits, and high costs. More appropriate treatment for MDS may reduce the burden associated with this condition.