PCN50 Cost of Chronic Myeloid Leukemia Care Among Patients in Advanced Phases or on Later Lines of Therapy in Chronic Phase in the United States From a Commercial and Medicare Perspective

Abstract

Tyrosine kinase inhibitors (TKIs) are standard-of-care treatment for chronic myeloid leukemia-chronic phase (CML-CP). Since many patients reach later lines due to resistance/intolerance or progress to accelerated phase/blast crisis (AP/BC), a better understanding of cost of care is needed. Adult patients with CML were identified in the IBM MarketScan (Q1/2001-Q2/2019) and SEER-Medicare (Q1/2006-Q4/2016) databases. Healthcare resource utilization (HRU: inpatient [IP] days and outpatient [OP] services) were measured among patients with (a) CML-CP on third-line therapy (CML-CP-3L), (b) CML-CP on fourth-line therapy or later (CML-CP-4L+), and (c) CML-AP/BC. Three-month incidence rates (IR) and event-level costs ($2019 USD), including 3-month terminal care and stem-cell transplant (SCT in IP settings) costs, were reported from a payer’s perspective. In commercial claims, 296 (4,620 patient-months), 83 (1,644 patient-months), and 949 (25,593 patient-months) patients were identified in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively. Three-month OP IR were 7.6, 8.3, and 7.0 services in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively, with mean costs of $597 per service. Three-month IP IR were 0.6, 0.7, and 1.4 days in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively, with mean costs of $5,892 per day. Mean costs were $107,013 for terminal care and $352,333 for SCT. In SEER-Medicare, 53 (738 patient-months), 12 (180 patient-months), and 222 patients (5,740 patient-months) were identified in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively. Three-month OP IR were 13.7, 20.0, and 13.8 services in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively, with mean costs of $230 per service. Three-month IP IR were 3.1, 1.5, and 3.6 days in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively, with mean costs of $2,945 per day. Mean costs were $54,793 for terminal care and $139,991 for SCT. Cost of CML care in the US is substantial among patients with CML who are in later lines of therapy or who progressed to AP/BC, suggesting unmet treatment needs.