The Healthcare Resource Utilization, Costs, and Predictors of Progression Among Relapsed and Refractory CLL Patients

Abstract

Background: Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia where the majority of patients (pts) experiences a relapse or becomes refractory after a first-line treatment. This study assesses the economic burden associated with early vs late disease progression among pts with relapsed and refractory (R/R) CLL and identifies factors that are associated with further disease progression. Method: CLL pts with an indicator of R/R disease were selected from the Truven MarketScan database (>25 million commercially insured lives annually; 2000-2013) based on diagnoses and treatment patterns. Pts were ≥18 years in age, continuously enrolled in their health plan for ≥6 months prior to (baseline period) and ≥1 month after the first indicator of R/R CLL. The index date was defined as the date of the first R/R indicator. As a first step, pts who progressed following the first indicator of R/R CLL were identified and classified into two mutually exclusive cohorts: 1) pts with early progression ( Results: Of the 4,387 R/R CLL pts selected, 2,238 (51%) pts had a progression following the first indicator of R/R CLL. Median time to first progression following the index date was 14.5 months. Among pts who progressed, 69.3% had early progression and 30.7% had late progression. Characteristics of pts with early vs late progression were similar in terms of age, sex ratio, and region of residence. The main differences between cohorts were in terms of baseline comorbidities - a higher proportion of pts in the early progression cohort had hypertension, deficiency anemias, and coagulation deficiency. Quan Charlson Comorbidity Index (CCI) was also higher in the early progression cohort compared to the late progression cohort (2.61 vs 2.48, p Conclusions: R/R CLL pts who experienced early progression had more comorbidities and incurred significantly higher healthcare resources and costs than pts with late progression, suggesting that delaying progression in the fast progressing R/R CLL pts can reduce the economic burden. Time from CLL diagnosis to R/R CLL and comorbidities were the main predictors of early progression. Disclosures Guerin:Janssen Scientific Affairs, Janssen-Ortho, Inc., Merck & Co., Inc., Merck Frosst Canada, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ogilvy Renault, Ortho-Clinical Diagnostics, Inc., Otsuka America Pharmaceutical, Inc.,:Consultancy; Pfizer Canada, Inc.,RXD AbbVie Inc., Alcon Laboratories, Bayer Healthcare Pharmaceuticals, LLC, Celgene Corporation, Cempra Inc., Centocor Ortho Biotech, Cooley LLP, Cyberonics, Inc., DLA Piper, Eli Lilly & Company,Forest Laboratories, Inc., Genentech, Inc., GlaxoSmithKline,: Consultancy, Other: Annie Guerin is an employee of Analysis Group Inc, which has received consultancy fees from AbbVie for this research. Ray:AbbVie Inc.: Employment, Other: Stock Holder . Gauthier:Sunovion Pharmaceuticals Inc.,Takeda Pharmaceuticals U.S.A., Inc.: Consultancy, Other: Genevieve Gauthier is an employee of Analysis Group Inc, which has received consultancy fees from the listed organizations; AbbVie Inc., Celgene Corporation, Eli Lilly & Company, Genentech, Inc., GlaxoSmithKline, Janssen Scientific Affairs, LLC, Novartis Pharmaceuticals Corporation, Pfizer Canada, Inc., Sanofi, Savient Pharmaceuticals, Inc., Shire Pharmaceuticals Inc.,:Consultancy, Other: Genevieve Gauthier is an employee of Analysis Group Inc, which has received consultancy fees from the listed organizations. Hsu:AbbVie Inc: Employment, Other: Stock holder . Zhdanava:AbbVie Inc., Genentech, Inc., Merck Frosst Canada, Novartis Pharmaceuticals Corporation,Shire Pharmaceuticals Inc., Takeda Pharmaceuticals U.S.A., Inc.: Other: Maryia Zhdanava is an employee of Analysis Group Inc, which has received consultancy fees from AbbVie for this research. Wu:Celgene Corporation, Centocor Ortho Biotech, Cephalon, Inc., ConvaTec Inc., Corus Pharma, Inc., Eli Lilly & Company, Eli Lilly & Company, Ethicon, Inc., Forest Laboratories, Inc., Genentech, Inc., GlaxoSmithKline, Janssen Global Services, LLC,: Consultancy; Janssen Pharmaceutica, Inc., Janssen Scientific Affairs, LLC, Lilly Research Laboratories, McNeil Consumer & Specialty Pharmaceuticals, MedImmune, LLC, Melinta Therapeutics, Inc., Millennium Pharmaceuticals, Inc.,: Consultancy; AbbVie Inc., Alcon Laboratory, Astellas Pharma Inc., Astellas Pharma US, Inc., AstraZeneca, Barger & Wolen LLP, Bayer Healthcare Pharmaceuticals, LLC, Biosense Webster, Inc., Blue Cross Blue Shield Association, Boehringer Ingelheim, Bristol-Myers Squibb: Consultancy, Other: Eric Q Wu, is an employee of Analysis Group which has received consultancy fees from AbbVie for this research; Molecular Insight Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Ortho McNeil Pharmaceuticals, Inc., Sanofi, Savient Pharmaceuticals, Inc., Shire Pharmaceuticals Inc.,: Consultancy; Takeda Global Research & Development Center, Inc., Takeda Pharmaceuticals U.S.A., Inc., TAP Pharmaceutical Products, Inc., Vertex Pharmaceuticals Incorporated: Consultancy.