All-cause Healthcare Resource Use Research Articles

Healthcare resource utilization among nursing home residents with Parkinson's disease psychosis: an analysis of Medicare beneficiaries treated with pimavanserin or other-atypical antipsychotics.

Aim: Real-world healthcare resource use (HCRU) burden among patients with Parkinson's disease psychosis (PDP) treated with pimavanserin (PIM) versus other atypical antipsychotics (other-AAPs) including quetiapine (QUE) in long term care (LTC) and nursing home (NH) settings are lacking. This analysis examines HCRU differences among residents in LTC/NH settings who initiate PIM versus QUE or other-AAPs. Methods: A retrospective analysis of LTC/NH residents with PDP from the 100% Medicare claims between 1 April 2015 and 31 December 2021 was conducted. Treatment-naive residents who initiated ≥6months continuous monotherapy with PIM or QUE or other-AAPs between 04/01/16 and06/30/2021 were propensity score matched (PSM) 1:1 using 31 variables (age, sex, race, region and 27 Elixhauser comorbidity characteristics). Post-index (i.e., 6months) HCRU outcomes included: proportion of residents with ≥1 all-cause inpatient (IP) hospitalizations and emergency room (ER) visits. HCRU differences were assessed via log binomial regression and reported as relative risk ratios (RR) and 95% confidence intervals after controlling for dementia, insomnia and index year. Results: From a total of PIM (n=1827), QUE (n=7770) or other-AAPs (n=9557), 1:1 matched sample (n=1827) in each cohort were selected. All-cause IP hospitalizations (PIM [29.8%]) versus QUE [36.7%]) and ER visits (PIM [47.3%] versus QUE [55.8%]), respectively, were significantly lower for PIM. PIM versus QUE cohort also had significantly lower RR for all-cause IP hospitalizations and ER visits, respectively, (IP hospitalizations RR: 0.82 [0.75. 0.9]; ER visits RR: 0.85 [0.8. 0.9]). PIM versus other-AAPs also had lower likelihood of HCRU outcomes. Conclusion: In this analysis, LTC/NH residents on PIM monotherapy (versus QUE) had a lower likelihood of all-cause hospitalizations (18%) and ER (15%) visits. In this setting, PIM also had lower likelihood of all-cause HCRU versus other-AAPs.

Real-World Health Care Resource Use and Costs Among Patients With Chronic Lymphocytic Leukemia Treated With Venetoclax-Based and Bruton Tyrosine Kinase Inhibitor–Based Regimens in the Second-Line Setting

PURPOSE Real-world evidence comparing health care resource use (HRU) and costs between novel targeted therapies among patients with chronic lymphocytic leukemia (CLL) is lacking. We compared all-cause and CLL-specific HRU and costs between patients initiated on B-cell lymphoma 2 inhibitor (venetoclax)– or Bruton tyrosine kinase inhibitor (BTKi)–based regimens in the second-line (2L) setting. METHODS This is a retrospective observational study using Optum Clinformatics Data Mart of adult patients with CLL/small lymphocytic lymphoma who received 2L venetoclax- or BTKi-based regimens (January 2018-December 2021) for the first time and had ≥one CLL diagnostic claim after 2L initiation and ≥two claims for venetoclax or BTKi. Baseline characteristics were balanced using stabilized inverse probability of treatment weights. Mean monthly cost difference (MMCD) between cohorts for all-cause and CLL-specific per patient per month (PPPM) costs was estimated. Rates of PPPM-HRU were compared between cohorts using rate ratios (RRs). RESULTS Of 280 patients, median age 75.5 years, 64.6% and 35.4% received BTKi- versus venetoclax-based regimens, respectively. Most BTKi-treated patients received monotherapy (88.4%), whereas 62.3% of venetoclax-treated patients received combination therapy with anti-CD20 agents. The median duration of 2L therapy was 11.6 and 11.0 months for BTKi versus venetoclax cohorts, respectively. All-cause total costs were lower for venetoclax versus BTKi (MMCD [SE], $–2,497.64 [$1,006.77] in US dollars (USD); P = .01), driven by lower medication costs offsetting medical costs; trends were similar for CLL-specific estimates. Outpatient HRU was higher for venetoclax versus BTKi (RR all-cause: 1.22 v CLL-specific: 1.64). CONCLUSION Venetoclax was associated with total monthly cost savings versus BTKis, illustrating the economic value of time-limited venetoclax-based regimens in the 2L setting.

Prevalence and burden of chronic cough in France.

Chronic cough is a common condition that is associated with lower health-related quality of life and greater healthcare resource use. There are limited data on the prevalence, population characteristics and burden of chronic cough in France. This was a cross-sectional study based on responses from French adult residents to the 2020 National Health and Wellness Survey. Respondents with chronic cough were compared to 1:3 propensity score-matched controls without chronic cough. The weighted lifetime and 12-month prevalence of chronic cough were estimated as 7.5% and 4.8%, respectively. Respondents with chronic cough reported significantly worse perceived health than matched controls, with lower mean±sd scores of 46.68±9.28 versus 50.42±8.26 on the physical health component and 40.32±9.87 versus 44.32± 9.69 on the mental health component of the Medical Outcomes Study 12-item Short Form Survey Version 2 survey (p<0.001 for both comparisons). Respondents with chronic cough also had higher rates of moderate-to-severe forms of anxiety (24.4% versus 12.4%) and depression (36.4% versus 20.2%); higher rates of multiple forms of sleep disturbance; greater impairment of work productivity (38.2% versus 25.5%) and other activities (41.8% versus 28.2%; p<0.001 for all comparisons). Respondents with chronic cough also had higher rates of all-cause healthcare resource use including emergency room visits, hospitalisation, and overall and specialist healthcare provider visits compared to controls (p<0.001 for all comparisons). Chronic cough is a common condition in France that is associated with lower health-related quality of life and greater healthcare resource utilisation.

Event-Free Survival as a Predictor of Overall Survival and Recurrence Burden of Patients with Non-Small Cell Lung Cancer Receiving Neoadjuvant Therapy

Event-free survival has replaced overall survival as a primary end point in many recent and ongoing clinical trials. This study aims to examine the correlation between real-world event-free survival and overall survival and to assess the clinical and economic burden associated with disease recurrence among patients with resected stage II to III non-small cell lung cancer who received neoadjuvant therapy in the United States. This retrospective study used the Surveillance, Epidemiology, and End Results Medicare database (2007-2019) to identify patients with newly diagnosed, resected, stage II to IIIB (N2) non-small cell lung cancer who received neoadjuvant therapy. The correlation between real-world event-free survival and overall survival was assessed using the normal scores rank correlation and landmark analysis. Overall survival, all-cause health care resource use and costs, and non-small cell lung cancer-related health care resource use and costs were compared between patients with and without recurrence. A total of 221 patients met the eligibility criteria (median follow-up time from neoadjuvant treatment initiation: 32.7months). The mean age was 72.1years, and 57.0% of patients were male. Real-world, event-free survival and overall survival are positively and significantly correlated (0.68; 95% CI, 0.52-0.79). Patients with recurrence had significantly shorter median overall survival (19.3 vs 116.9months), 4.59 times increased risk of death (95% CI, 2.56-8.26), and significantly higher all-cause and non-small cell lung cancer-related health care resource use and costs (adjusted mean monthly costs per patient difference: $5758 and $3187, respectively [all P<.001]). These findings help validate event-free survival as a clinically meaningful end point and strong predictor for overall survival and highlight the need for additional novel therapies that may delay or prevent recurrence in resectable stage II and III non-small cell lung cancer.

Real-World Treatment Patterns, Overall Survival, Healthcare Resource Utilization, and Costs Among U.S. Elderly Patients with Mantle Cell Lymphoma (MCL) after Failure of Covalent Btki Treatment

Background: Over the past decade, Bruton's tyrosine kinase inhibitors (BTKis) have emerged as standard of care treatment for relapsed/refractory mantle cell lymphoma (R/R MCL). Despite improvements in progression-free survival with currently available covalent BTKis (cBTKis), response duration can be limited as patients eventually experience disease progression or treatment intolerance. Limited real-world evidence on post-cBTKi clinical and economic outcomes exists for these patients. The goal of this study was to examine treatment patterns, overall survival (OS), healthcare resource use (HRU), and costs in elderly U.S. patients with R/R MCL in the third-line (3L) setting who received first-generation or second-generation cBTKi treatment in prior lines of therapy (i.e. 1L or 2L). Methods: This retrospective study used 2010-2019 U.S. Medicare claims (100%), the most recently available data at the time of the analysis, to identify elderly (≥66 years) patients with a new MCL diagnosis between 01/01/2010 and 12/31/2018 (index date = first MCL diagnosis date). Patients were required to have continuous fee-for-service Medicare coverage in the 12-months pre- and a minimum of 12-months post-index. An algorithm to identify lines of therapy (LOT) was developed using prior published studies. Patients were included in our final sample if they had evidence of use of a cBTKi (i.e. ibrutinib or acalabrutinib, the two available BTKIs during our study period) in the 1L and/or 2L setting and had progressed to 3L treatment. Outcomes included patient clinical and sociodemographic characteristics, treatment patterns, all-cause and MCL-related HRU and costs, and median OS after 3L treatment initiation. Results: The final sample contained 230 elderly patients with R/R MCL receiving 3L treatment who had cBTKi use in a prior LOT. The vast majority (&amp;gt;95%) of these patients had received their cBTKi in the 2L setting; the most common cBTKi in the 1L (100%) and 2L (&amp;gt;93%) setting was ibrutinib. Patients had a mean age of 75.0 years (SD=5.9) and 21.7% were age &amp;gt;80 years. Over two-thirds (67.4%) were male and majority (93.9%) were white. About one-quarter (25.7%) of the patients received a cBTKi (17.8% ibrutinib and 7.8% acalabrutinib) in the 3L setting. Other common 3L treatments included standard chemotherapy (26.1%), lenalidomide (18.7%), and bortezomib (18.3%). Over a median follow-up of 1.6 years, 38.7% of the patients progressed to fourth-line (4L) treatment and the mean time to next treatment (i.e. end of 3L to start of 4L) was 2.8 months. Median OS from 3L treatment initiation was 9.4 months and the 1-year and 3-year survival rates were 43.7% and 17.9%, respectively. All-cause hospitalization was common (73.6%) and 44.7% used hospice services in the 12 months after 3L treatment initiation. All-cause total costs were substantial ($145,726) in the 12 months following 3L treatment initiation and 87% of these costs were MCL-related ($126,526). Inpatient and outpatient costs in the 12 months following 3L treatment initiation were $32,520 and $19,370, respectively (these costs were higher in the subgroup of patients who progressed to 4L therapy). MCL-related prescription costs ($70,127) represented over half (55%) of MCL-related total spending; most of those costs were for Part D oral agents ($43,009) rather than Part B IV-administered agents ($27,119). Conclusions: In this real-world study of elderly U.S. patients with R/R MCL, we found that 3L patients treated with currently available cBTKis in prior lines had poor OS. Limited options for 3L treatment existed, with over half of patients using another cBTKi or standard chemotherapy. Further, rates of HRU were high and healthcare costs were substantial in the 3L setting. Our study suggests there is a large unmet need in elderly patients with R/R MCL who previously failed a cBTKi, highlighting the importance of ongoing development with novel therapeutics aiming to improve outcomes in R/R MCL.

Migraine treatment and healthcare resource utilization in Alberta, Canada.

Migraine poses a significant burden worldwide; however, there is limited evidence as to the burden in Canada. This study examined the treatment patterns, healthcare resource use (HRU), and costs among newly diagnosed or recurrent patients with migraine in Alberta, Canada, from the time of diagnosis or recurrence. This retrospective observational study utilized administrative health data from Alberta, Canada. Patients were included in the Total Migraine Cohort if they had: (1) ≥1 International Classification of Diseases diagnostic code for migraine; or (2) ≥1 prescription dispense(s) for triptans from April 1, 2012, to March 31, 2018, with no previous diagnosis or dispensation code from April 1, 2010, to April 1, 2012. The mean age of the cohort (n = 199,931) was 40.0 years and 72.3% were women. The most common comorbidity was depression (19.7%). In each medication class examined, less than one-third of the cohort was prescribed triptans and fewer than one-fifth was prescribed a preventive. Among patients with ≥1 dispense, the mean rate of opioid prescriptions was 4.61 per patient-year, compared to 2.28 triptan prescriptions per patient-year. Migraine-related HRU accounted for 3%-10% of all use. Comorbidities and high all-cause HRU were observed among newly diagnosed or recurrent patients with migraine. There is an underutilization of acute and preventive medications in the management of migraine. The high rate of opioid use reinforces the suboptimal management of migraine in Alberta. Migraine management may improve by educating healthcare professionals to optimize treatment strategies.

Healthcare Resource Use and Costs Associated with Organ Damage in Newly Diagnosed Adults with Systemic Lupus Erythematosus in the UK.

This analysis compared healthcare resource use (HCRU) and costs associated with incident organ damage in a cohort of adult patients with systemic lupus erythematosus (SLE). Incident SLE cases were identified (Clinical Practice Research Datalink [CPRD] and Hospital Episode Statistics-linked healthcare databases; January1, 2005-June30, 2019). Annual incidence of 13 organ damage domains was calculated from SLE diagnosis through follow-up. Annualized HCRU and costs were compared between organ damage and non-organ damage patient groups using generalized estimating equations. A total of 936 patients met the inclusion criteria for SLE. Mean age was 48.0 (standard deviation [SD] 15.7) years and 88% were female. Over a median follow-up period of 4.3 (interquartile range [IQR] 1.9-7.0) years, 59% (315/533) had evidence of post-SLE diagnosis incident organ damage (≥ 1 type), which was greatest for musculoskeletal (146/819 [18%]), cardiovascular (149/842 [18%]), and skin (148/856 [17%]) domains. Patients with organ damage had greater resource use for all organ systems, excluding gonadal, versus those without it. Overall, mean (SD) annualized all-cause HCRU was greater in patients with organ damage versus those without it (inpatient, 1.0 versus 0.2; outpatient, 7.3 versus 3.5; accident and emergency, 0.5 versus 0.2days; primary care contacts, 28.7 versus 16.5; prescription medications, 62.3 versus 22.9). Adjusted mean annualized all-cause costs were significantly greater in both post- and pre-organ damage index periods for patients with organ damage versus those without it (all P < 0.05, excluding gonadal). Overall organ damage was associated with significantly increased adjusted mean annualized per-patient cost (£4442 greater [P < 0.0001]) ranging between £2709 and £7150 greater depending on the organ damage type. Organ damage was associated with higher HCRU and healthcare costs, before and after SLE diagnosis. More effective SLE management may slow disease progression, prevent organ damage onset, improve clinical outcomes, and reduce healthcare costs.

Esketamine nasal spray for major depressive disorder with acute suicidal ideation or behavior: description of treatment access, utilization, and claims-based outcomes in the United States

AimsTo describe real-world esketamine nasal spray access and use as well as healthcare resource use (HRU) and costs among adults with evidence of major depressive disorder (MDD) with suicidal ideation or behavior (MDSI).MethodsAdults with ≥1 claim for esketamine nasal spray and evidence of MDSI 12 months before/on the date of esketamine initiation (index date) were selected from Clarivate’s Real World Data product (01/2016–03/2021). Patients initiated esketamine on/after 03/05/2019 (esketamine approval for treatment-resistant depression; later approved for MDSI on 08/05/2020) were included in the overall cohort. Esketamine access (measured as approved/abandoned/rejected claims) and use were described post-index; HRU and healthcare costs (2021 USD) were described over 6 months pre- and post-index.ResultsAmong 269 patients in the overall cohort with esketamine pharmacy claims, 46.8% had the first pharmacy claim approved, 38.7% had it rejected, and 14.5% abandoned their claim; 169 patients were initiated on esketamine in the overall cohort (mean age 40.9 years, 62.1% female); 45.0% had ≥8 esketamine treatment sessions (recommended per label) with a mean [median] of 85.0 [58.5] days from index to 8th session (per label 28 days). Among 115 patients with ≥6 months of data post-index, in the 6-month pre- and post-index, respectively, 37.4 and 19.1% had all-cause inpatient admissions, 42.6 and 33.9% had emergency department visits, 92.2 and 81.7% had outpatient visits; mean ± standard deviation all-cause monthly total healthcare costs were $8,371±$15,792 and $6,486±$7,614, respectively.LimitationsThis was a descriptive claims-based analysis; no formal statistical comparisons were performed due to limited sample size as data covered up to 24 months of esketamine use in the US clinical setting.ConclusionsNearly half of patients experience access issues with first esketamine nasal spray treatment session. All-cause HRU and healthcare costs trend lower in the 6 months after relative to 6 months before esketamine initiation.

Retrospective Cohort Study to Quantify the Economic Impact of Mild Cognitive Impairment (P7-6.002)

<h3>Objective:</h3> To measure all-cause healthcare resource use (HCRU) and costs of MCI subjects. <h3>Background:</h3> The economic burden of mild cognitive impairment (MCI), characterized by memory impairment or other cognitive decline, is poorly understood. <h3>Design/Methods:</h3> This retrospective cohort study used MarketScan® data (1 Jan 2014–31 Dec 2019) to identify subjects (“MCI cohort”) who: (1)were ≥50 years old; (2)had ≥1 MCI claim (ICD-9 331.83 or ICD-10 G31.84); (3)had no Alzheimer’s disease or related dementia (ADRD) ICD codes or medications pre-index date (first ICD code for MCI); and, (4)had continuous enrollment for ≥2 years pre-/≥1 year post-index date. Subjects in a “control cohort” without MCI, ADRD or ADRD-related medications were matched by age, sex, geography, and index year. Subjects with Parkinson’s disease were excluded. Pair-wise t-test and chi² test were used to compare continuous and categorical variables, respectively. Logistic regression estimated odds ratios (ORs) for risk of medical conditions. Generalized linear models were used to compare HCRU and costs in the first 12 months post-index. <h3>Results:</h3> The study included 5,185 MCI and 15,555 control subjects (age 67 years, 58% female). The MCI cohort had higher Charlson and Elixhauser Comorbidity Indices than controls (1.5 vs 1.0 and 2.6 vs 1.8, respectively; p&lt;0.0001). The MCI cohort had significantly higher risk for depression (OR=3.8) and stroke/transient ischemic attack (OR=3.3). Mean adjusted inpatient (0.3 vs 0.1), emergency (0.6 vs 0.3) and outpatient (29.1 vs 14.1) visits, and inpatient length of stay (09 vs 0.3 days) were higher in the MCI vs control cohort (all p&lt;0.0001). Mean adjusted total costs were higher for the MCI vs control cohorts ($30,453 vs $13,376, p&lt;0.0001). <h3>Conclusions:</h3> Despite the perception of being a mild condition, MCI was associated with more than double the economic burden. As the US population ages, early identification and intervention are key to delay progression on the Alzheimer’s disease continuum. <b>Disclosure:</b> Dr. Frech has received personal compensation for serving as an employee of Eisai Inc. Dr. Li has received personal compensation for serving as an employee of Eisai Inc. Ms. Ding has received personal compensation for serving as an employee of Genesis Research. Mrs. Ndiba-Markey has received personal compensation for serving as an employee of Genesis Research. Mr. Rava has received personal compensation for serving as an employee of Genesis Research. Richard Batrla has nothing to disclose. Harald Hampel has received personal compensation for serving as an employee of Eisai Inc..

Healthcare Resource Utilization and Costs in Patients with EGFR-Mutated Advanced Non-Small Cell Lung Cancer Receiving First-Line Treatment in the United States: An Insurance Claims-Based Descriptive Analysis.

An estimated 10-15% of non-small cell lung cancer (NSCLC) cases present with epidermal growth factor receptor mutation (EGFRm). While EGFR tyrosine kinase inhibitors (EGFR-TKIs) such as osimertinib have become first-line (1L) standard of care for these patients, limited chemotherapy use still occurs in real-world practice. Studies of healthcare resource use (HRU) and cost of care provide a means by which the value of various treatment regimens, healthcare efficiency, and disease burden can be assessed. These studies are important for population health decision makers and health systems that prioritize value-based care to drive population health. The aim of this study was to descriptively assess HRU and costs among patients with EGFRm advanced NSCLC initiating 1L therapy in the United States. IBM MarketScan Research Databases (January 1, 2017 to April 30, 2020) were used to identify adult patients with advanced NSCLC, based on a diagnosis for lung cancer (LC) and initiation of 1L therapy or diagnosis of metastases within 30 days of the first LC diagnosis. All patients had ≥ 12 months of continuous insurance eligibility prior to the first LC diagnosis and initiated (in 2018 or after) an EGFR-TKI during any line of therapy to proxy EGFRm status. Per-patient-per-month all-cause HRU and costs were described during 1L for patients initiating 1L osimertinib or chemotherapy. A total of 213 patients with advanced EGFRm NSCLC were identified (mean age at 1L initiation: 60.9 years; 69.0% female). In 1L, 66.2% initiated osimertinib, 21.1% chemotherapy, and 12.7% another regimen. Mean 1L therapy duration was 8.8 months (osimertinib) and 7.6 months (chemotherapy), respectively. Among osimertinib recipients, 28% had an inpatient admission, 40% an emergency room (ER) visit, and 99% an outpatient visit. Among chemotherapy recipients, these proportions were 22%, 31%, and 100%. Mean monthly all-cause healthcare costs among osimertinib and chemotherapy patients were US$27,174 and US$23,343, respectively. Among osimertinib recipients, drug-related costs (including pharmacy and outpatient antineoplastic drug and administration costs) made up 61% (US$16,673) of total costs, inpatient costs 20% (US$5462), and other outpatient costs 16% (US$4432). In chemotherapy recipients, 59% (US$13,883) of total costs were drug-related, 5% (US$1166) were inpatient costs, and 33% (US$7734) other outpatient costs. Higher mean total cost of care was observed among patients receiving 1L TKI (osimertinib) than 1L chemotherapy in EGFRm advanced NSCLC. However, descriptive differences in type of spending and HRU were identified: higher inpatient costs and inpatient days for osimertinib versus higher outpatient costs for chemotherapy. Findings suggest that significant unmet needs may remain for 1L treatment of EGFRm NSCLC, and despite significant advances in targeted care, further individualized therapies are needed to balance benefits, risks, and total cost of care. Furthermore, observed descriptive differences in inpatient admissions may have implications for quality of care and patient quality of life, for which additional research is warranted.

Real-World Treatment Patterns, Healthcare Resource Use, and Costs Among Patients with Diffuse Large B-Cell Lymphoma: A Retrospective Analysis of US Claims Data

Introduction: Diffuse large B-cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin's lymphoma with high economic burden and a strong pipeline of novel therapies. To better understand this rapidly evolving treatment landscape and current economic burden in DLBCL, this study describes real-world treatment patterns, healthcare resource use (HRU), and costs in DLBCL patients in the US, overall and by line of therapy (LOT). Methods: Optum Clinformatics claims data from October 2015 to June 2020 were used to identify adult patients with ≥2 diagnosis codes for DLBCL on ≥2 distinct dates within 12 months. The index date was defined as the date of the first observed DLBCL diagnosis. Continuous enrollment was required for ≥12 months pre-index (i.e., baseline period) and ≥1-month post-index. Patients with diagnosis codes for DLBCL or any other malignancy during baseline were excluded to increase the likelihood of capturing newly diagnosed patients. Demographic and clinical characteristics were assessed during baseline, and all-cause and DLBCL-related HRU (monthly incidence rates and 95% confidence intervals [CI]) and costs (per patient per month [PPPM]) were estimated from the index date to the earliest of end of either continuous enrollment or study period. A LOT algorithm was developed to identify lines of National Comprehensive Cancer Network (NCCN)-recommended systemic therapies, stem cell transplantation (SCT), and chimeric antigen receptor (CAR)-T therapies during the study period among a subset of patients with no claims for treatments of interest during the baseline period and ≥1 claim for treatment during the study period. HRU and costs were described during the first line (1L), second line (2L), and third and subsequent line (3L+) periods. Results: A total of 3,664 patients with DLBCL were included in the study and followed for a mean duration of 18 months post-DLBCL diagnosis. Patients were on average 70 years old, with 47% females, and 75% covered by Medicare. Mean National Cancer Institute Comorbidity Index (NCICI) was 2.2 and the most prevalent comorbidities were cardiovascular disease (32%), diabetes (29%), and chronic obstructive pulmonary disease (24%). On average, patients had 0.13 (95% CI: 0.13, 0.14) all-cause hospitalizations, 3.31 (3.29, 3.32) outpatient visits, 0.07 (0.06, 0.07) emergency room (ER) visits, and 0.15 (0.14, 0.15) other visits PPPM (Table 1). Almost all hospitalizations were DLBCL-related (0.12 PPPM), while outpatient, ER, and other visits were less driven by DLBCL-related visits (1.3, 0.01, and 0.04 visits PPPM respectively). Total all-cause costs were $19,686 PPPM and largely consisted of DLBCL-related medical costs ($16,803). Costs from DLBCL-related hospitalizations accounted for roughly half of the total all-cause costs ($10,704). A total of 2,234 patients (61%) were included for the treatment pattern analysis after applying additional inclusion criteria. Of those, 376 (17%) received a treatment of interest in the relapsed/refractory setting. Rituximab, cyclophosphamide, hydroxydaunorubicin hydrochloride, vincristine, and prednisone (R-CHOP) was the most common treatment in 1L (50%), followed by CHOP (29%) (Table 2). In the 2L setting, R-CHOP (15%), bendamustine-based therapies (14%), and SCT (13%) were the most common regimens. Bendamustine-based therapies (21%), gemcitabine-based regimens (13%), lenalidomide-based therapies (11%), and CAR-T therapy (11%) were commonly used in 3L. Mean treatment duration decreased with increasing lines of therapy (111 days for 1L, 98 days for 2L, and 81 days for 3L). All-cause and DLBCL-related HRU and costs tended to increase with increasing lines of therapy and were generally highest for 3L+ (Table 1). This was especially true for DLBCL-related hospitalization costs, which increased from $5,242 PPPM in 1L to $18,309 PPPM in 3L+ and accounted for increasingly larger proportions of total all-cause costs with increasing lines. Conclusions: This study summarizes the current treatment landscape and economic burden for DLBCL in the US. Results show that various therapies are being used for DLBCL management and quantify the high HRU and cost burden among patients with DLBCL, especially during later lines of therapy, highlighting an area of unmet need. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Economic Burden and Treatment Patterns Among Patients with Mantle Cell Lymphoma in the US: A Retrospective Claims Analysis

Introduction: Mantle cell lymphoma (MCL) is a rare, aggressive form of non-Hodgkin's lymphoma with relatively poor prognosis compared to other B-cell malignancies, high economic burden, and a changing treatment landscape with recent therapeutic advances. This study describes current treatment patterns, healthcare resource use (HRU), and costs in patients with MCL in the US. Methods: Adult patients with ≥2 diagnosis codes for MCL on ≥2 distinct dates within 12 months were identified in Optum Clinformatics claims data from 10/1/2015 to 3/31/2021. The first observed MCL diagnosis was considered the index date. The baseline period was defined as the 12 months of continuous enrollment pre-index; continuous enrollment was also required for ≥1 month post-index. Patients with diagnosis codes for MCL or other malignancies during baseline were excluded. The study period spanned from the index date till the earliest of either end of continuous enrollment or end of data availability. Demographic and clinical characteristics were described during the baseline period. All-cause and MCL-related HRU in terms of monthly incidence rates and 95% confidence intervals (CI) and per patient per month (PPPM) costs were described during the study period. A subset of patients meeting the following additional criteria were included in the treatment sequence analysis: no claims for treatments of interest during the baseline period and ≥1 claim for treatments during the study period. Treatments of interest included National Comprehensive Cancer Network (NCCN)-recommended systemic therapies, stem cell transplantation (SCT), and chimeric antigen receptor (CAR)-T therapy. An algorithm was developed to identify treatments in first line (1L), second line (2L), and third line (3L) during the study period. HRU and costs were described during the 1L, 2L, and third and subsequent line (3L+) periods. Results: The study included 696 patients with MCL, with a mean follow-up time of 22 months. Patients had a mean age of 71 years and were predominantly male (68%), with most having Medicare coverage (76%). The most common comorbidities during baseline were cardiovascular disease (29%), diabetes (27%), and chronic obstructive pulmonary disease (24%), with a mean National Cancer Institute Comorbidity Index (NCICI) of 1.9. During the study period, there were 0.13 (95% confidence interval: 0.12, 0.14) all-cause hospitalizations, 3.27 outpatient visits (3.24, 3.30), 0.06 (0.06, 0.07) emergency room (ER) visits, and 0.18 (0.18, 0.19) other visits PPPM (Table 1). Majority of hospitalizations were MCL-related (0.09 PPPM). MCL-related outpatient visits (1.57 PPPM), ER visits (0.01 PPPM), and other visits (0.06 PPPM) formed a lower proportion of all-cause visits. Patients had considerable total all-cause costs ($23,884 PPPM), almost all of which were medical costs ($22,717 PPPM). MCL-related medical costs contributed substantially to all-cause costs ($19,771 PPPM), largely due to MCL-related hospitalizations ($12,785 PPPM). 399 patients (57%) who received a treatment of interest during the study period were included in the treatment pattern analysis. Among these patients, 129 (32%) were observed to receive a treatment of interest in 2 or more lines. Bendamustine-based therapies were most used in 1L (51%), followed by SCT and rituximab monotherapy (11% each) (Table 2). Ibrutinib-based therapies were the most common in 2L (28%) and 3L (24%). Mean treatment duration decreased with increasing lines of therapy (173 days for 1L, 154 days for 2L, and 139 days for 3L). All-cause and MCL-related HRU and costs tended to increase with increasing lines of therapy (Table 1) - for example, hospitalization costs were twice as high in 3L+ ($24,314 PPPM for all-cause and $22,840 PPPM for MCL-related hospitalizations) than in 1L ($12,366 PPPM for all-cause and $11,162 PPPM for MCL-related hospitalizations). Conclusions: This study describes the contemporary treatment patterns and economic burden for MCL in the US. Results show that a range of treatments are used to manage MCL, with more recently approved therapies such as ibrutinib being used more commonly in later lines. This study also highlights high HRU and cost burden among patients with MCL, which increases with subsequent lines of therapy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Real-World Treatment Patterns, Healthcare Resource Utilization, Costs, and Survival Among Medicare Beneficiaries with Diffuse Large B-Cell Lymphoma (DLBCL)

Background: Given the prevalence of DLBCL and ongoing development of novel therapies, it is important to understand real-world treatment patterns and economic burden in individuals diagnosed with DLBCL. With a median age at diagnosis of 66 years, specific attention to older adults with DLBCL is needed, yet the current literature is limited in this respect. This study aimed to examine treatment patterns, healthcare resource use (HRU), costs, and survival in a national sample of Medicare beneficiaries newly diagnosed with DLBCL. Methods: This cohort study used Medicare claims data (100%) from 2014 to 2019, the most recently available data at the time of the analysis. The sample included patients with a DLBCL diagnosis between 10/01/2015 to 12/31/2018 (index date = first DLBCL claim date). Additional selection criteria included: continuous Medicare fee-for-service Part A, B, and D coverage in the 12 months pre-index and a minimum of 12 months post-index, no diagnoses for DLBCL and absence of any anticancer treatment in the 12 months pre-index (i.e. incident cases), ≥66 years on index date, and evidence of at least one DLBCL-indicated treatment over follow-up after initial DLBCL diagnosis. Outcomes were reported for the front-line and relapse/refractory settings: (1) treatment patterns (2) Annual all-cause and DLBCL-related HRU (inpatient, outpatient, and physician visits, and hospice care), (3) all-cause and DLBCL-related annual costs, and (4) overall survival (OS). Results: We identified 11,880 Medicare beneficiaries diagnosed with DLBCL receiving treatment in the frontline setting (mean age 76.5 years, 31.6% age ≥80 years; 50.9% male; 90.0% White). Over a median follow up of 2.1 years, 17.8% went on to receive at least second-line treatment [2L+], 3.9% received at least third-line treatment [3L+], and 0.9% received at least fourth-line treatment [4L+]. Very few patients received a stem cell transplant (3.1%). Median time to treatment initiation from diagnosis was 32.0 days. The majority of frontline patients initiated R-CHOP (61.2%); 8.9% of patients received rituximab monotherapy in the 1L setting. In the relapsed/refractory setting, the most common regimens were bendamustine-based regimens (20.3% [2L+], 20.8% [3L+], 13.6% [4L+]), gemcitabine-based regimens (18.2% [2L+], 20.2% [3L+], 19.1% [4L+]), and CHOP-based regimens (21.1% [2L+], 7.3% [3L+], <10% [4L+]). The median time to next treatment from the end of the previous line of treatment ranged from about 3 weeks to 7 weeks (51.0 days from 1L to 2L, 35.5 days from 2L to 3L, and 20.5 days from 3L to 4L). HRU was substantial across all lines of therapy in the 12 months after initiating a given line of treatment. Over half of patients (57%) had a hospitalization due to any cause, with the vast majority being DLBCL-related. Hospice use increased in each line of therapy (13% [1L+], 32% [2L+], 44% [3L+], 59% [4L+]). Across all lines of therapy, >70% of all-cause costs are attributable to DLBCL. DLBCL-related total healthcare costs in the 12 months after initiation of treatment were $84,416 (1L+), $80,757 (2L+), $91,493 (3L+), and $74,294 (4L+). Excluding patients who died within 12-months of treatment initiation, DLBCL-related total costs were higher for later lines of treatment ($80,761 [2L+], $118,278 [3L+], $124,134 [4L+]). Less than half of DLBCL-related total costs were attributable to DLBCL-related oral and physician-administered drugs (44% [1L+], 39% [2L+], 37% [3L+], 44% [4L+]). Median OS from initial DLBCL diagnosis or 1L treatment initiation was not reached. Median OS was 19.9 months, 9.8 months, and 5.5 months from the initiation of 2L, 3L, and 4L treatment, respectively. The 1-year and 3-year OS rate was 81.7% and 65.8% from initial DLBCL diagnosis and 78.9% and 64.3% from 1L treatment initiation, respectively. The 1-year and 3-year OS rate was 58.3% and 39.9% from 2L treatment initiation, and 45.1% and 19.8% from 3L treatment initiation, respectively. Conclusions: In this real-world study of a national sample of elderly U.S. Medicare beneficiaries diagnosed with DLBCL, we observed high rates of hospitalization and hospice use, poor overall survival in later lines of therapy, and substantial healthcare costs. Our study results when taken together are suggestive of a large current unmet need for more efficacious and well-tolerated therapies for older adults with DLBCL patients in both the front-line and relapse/refractory settings.

Direct health care costs associated with COVID-19 in the United States.

BACKGROUND: Data on the real-world health care burden of COVID-19 in the United States are limited. OBJECTIVE: To compare health care resource use (HRU), direct health care costs, and long-term COVID-19-related complications between patients with vs patients without COVID-19 diagnoses. METHODS: Using IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits administrative claims databases (January 1, 2018, to March 1, 2021), this retrospective, matched cohort study compared patients with a recorded COVID-19 diagnosis to control subjects with no recorded diagnosis for COVID-19, personal history of COVID-19, or pneumonia due to COVID-19. To capture typical health care utilization, the control group was analyzed in 2019 (prepandemic); their index date was assigned as 1 year before the index date (first observed COVID-19 diagnosis) of their matched COVID-19 patient. All patients had continuous health plan coverage for at least 6 months pre-index (baseline) and at least 6 months post-index (allowing censoring during month 6). Separately for commercial and Medicare cohorts, COVID-19 and control patients were matched 1:1 using propensity scores, number of followup months, and indicator of age 18 years or older. During each month of the 6-month follow-up, all-cause HRU, health care costs, and COVID-19-related complications were compared between patients with COVID-19 and controls. RESULTS: After matching COVID-19 and control patients 1:1, a total of 150,731 commercial matched pairs and 1,862 Medicare matched pairs were retained; baseline characteristics were similar between patients with COVID-19 and controls. Patients with COVID-19 and controls had mean ages of 38.9 and 39.7 years in the commercial cohort and 74.3 and 75.3 years in the Medicare cohort, respectively. In month 1 of follow-up, patients with COVID-19 relative to controls were significantly more likely to have at least 1 inpatient admission (commercial: 6.9% vs 0.5%; Medicare: 29.1% vs 1.3%; both P < 0.001) and at least 1 emergency department visit (commercial: 37.3% vs 3.4%; Medicare: 26.2% vs 4.1%; both P < 0.001). Total health care costs in month 1 were significantly higher among patients with COVID-19 than controls (mean differences: $3,706 for commercial; $10,595 for Medicare; both P < 0.001), driven by inpatient costs. Though the incremental HRU and cost burden of COVID-19 decreased over time, patients with COVID-19 continued to have significantly higher total costs through month 5 (all P < 0.001 for both commercial and Medicare). During follow-up, patients with COVID-19 had significantly higher rates of complications than controls (commercial: 52.8% vs 29.0% with any; Medicare: 74.5% vs 47.9% with any; both P < 0.001), most commonly cough, dyspnea, and fatigue. CONCLUSIONS: COVID-19 was associated with significant economic and clinical burden, both in the short-term and over 6 months following diagnosis. DISCLOSURES: Jessica K DeMartino is an employee of Janssen Scientific Affairs, LLC. Elyse Swallow, Debbie Goldschmidt, Karen Yang, Marta Viola, Tyler Radtke, and Noam Kirson are employees of Analysis Group, Inc., which has received consulting fees from Janssen Scientific Affairs, LLC. This study was funded by Janssen Scientific Affairs, LLC. The sponsor was involved in the study design, interpretation of the results, manuscript review, and the decision to publish the article.

Apixaban versus other anticoagulants in patients with nonvalvular fibrillation: a comparison of all-cause and event-related costs in real-life setting in France

ObjectivesCompare costs associated with all-cause healthcare resource use (HCRU), stroke/systemic thromboembolism (STE) and major bleedings (MB) between patients with non-valvular atrial fibrillation (NVAF) initiating apixaban or other oral anticoagulants (OACs).MethodsWe performed a retrospective cohort study using the French healthcare claims database, including NVAF patients between 2014/01/01 and 2016/12/31, followed until 2016/12/31. We used 4 sub-cohorts of OAC-naive patients, respectively initiating apixaban, dabigatran, rivaroxaban or VKAs. We matched patients initiating apixaban with patients initiating each other OACs using 1:n propensity score matching. All-cause HCRU and event-related costs by OAC treatment were estimated and compared between matched patients using generalised-linear models with gamma-distribution and two-part models.ResultsThere were 175,766 patients in the apixaban–VKA, 181,809 in the apixaban–rivaroxaban, and 42,490 in the apixaban–dabigatran matched cohorts. Patients initiating apixaban had significantly lower HCRU costs than patients initiating VKA (€1,105 vs. €1,578, p < 0.0001), dabigatran (€993 vs. €1,140, p < 0.0001) and rivaroxaban (€1,013 vs. €1,088 p < 0.0001). They have had significantly lower costs related to stroke/STE and MB than patients initiating VKA (respectively, €183 vs. €449 and €147 vs. €413; p < 0.0001), rivaroxaban (respectively, €145 vs. €197 and €129 vs. €193; p < 0.0001), and lower costs related to stroke/STE than patients initiating dabigatran (€135 vs. €192, p < 0.02). Costs related to MB were not significantly different in patients initiating apixaban and those initiating dabigatran (€119 vs. €149, p = 0.07).ConclusionsHCRU and most event-related costs were lower in patients initiating apixaban compared to other OACs. Apixaban may be cost-saving compared to VKAs, and significantly cheaper than other DOACs, although cost differences are limited.

Economic and humanistic burden of ovarian cancer in the United States (392)

Economic and humanistic burden of ovarian cancer in the United States (392)

Comparative Analysis of All-Cause Health Care Resource Utilization and Costs Among Venous Thrombosis Patients Without Cancer Prescribed Apixaban or VKAs in France.

IntroductionThe direct oral anticoagulant (DOAC) apixaban has shown to have non-inferior efficacy and better safety than vitamin K antagonists (VKAs) in patients with venous thromboembolism (VTE). We determined whether healthcare resource use (HCRU) and direct all-cause medical and non-medical costs in patients with VTE in France differed between VKAs and apixaban.MethodsA retrospective cohort study was conducted using French national health data from January 2013–June 2018 for anticoagulant-naïve adults hospitalized with VTE. All-cause costs and HCRU per patient per month (PPPM) were compared between apixaban and VKA cohorts created by 1:1 propensity score matching. Two-part models with bootstrapping were used to calculate marginal effects for costs and HCRU.ResultsThe matched VKA and apixaban cohorts each comprised 7503 patients. Compared to VKAs, patients prescribed apixaban had significantly lower (P < 0.0001) mean all-cause costs PPPM for outpatient visits (€438.54 vs. €455.58), overall laboratory tests (€21.26 vs. €83.73), and hospitalizations (€249.48 vs. €343.82), but significantly higher (P < 0.0001) mean all-cause costs PPPM for overall drugs (€97.06 vs. €69.56) and medical procedures (€42.12 vs. €35.50). Mean total all-cause direct medical costs (€687.93 vs. €798.70) and total all-cause direct medical and non-medical costs (€771.60 vs. €883.66) were significantly lower (P < 0.0001) for apixaban. Mean HCRU PPPM showed similar trends. Subgroup analyses showed that, among patients with recurrent VTE, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (€17.26 vs. €18.12) and total all-cause direct medical and non-medical costs (€18.37 vs. €19.20) than patients prescribed VKAs. Similarly, among patients with bleeding, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (€15.34 vs. €32.61) and total all-cause direct medical and non-medical costs (€16.23 vs. €34.63) than patients prescribed VKAs.ConclusionCompared to VKAs, apixaban may be cost-saving in the treatment of patients hospitalized for acute VTE.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02200-7.

The Economic Burden of Eosinophilic Gastritis and Eosinophilic Enteritis in the United States.

IntroductionEosinophilic gastritis and eosinophilic enteritis (EoG/EoN) are associated with a substantial clinical burden. However, limited information is available regarding the economic burden of EoG/EoN. This study was conducted to compare healthcare resource use (HRU) and costs among patients with EoG/EoN versus without EoG/EoN in the USA.MethodsAdministrative claims data from the IBM MarketScan® Commercial Claims and Encounters (CCAE) and Medicare Supplemental and Coordination of Benefits Databases (2009–2019) was used to identify two cohorts of patients. Patients without EoG/EoN were matched 3:1 to patients with EoG/EoN on sex, year of birth, and healthcare plan type. Study measures included demographic characteristics, select comorbidities, all-cause HRU, and costs. Comparisons were made over a 1-year period following EoG/EoN diagnosis for patients with EoG/EoN and an eligible date for patients without EoG/EoN.ResultsA total of 2219 patients with EoG/EoN and 6657 patients without EoG/EoN were analyzed. Significantly higher proportions of patients with EoG/EoN versus without EoG/EoN had comorbid conditions. Rates of all-cause HRU were significantly higher among patients with EoG/EoN versus patients without EoG/EoN (adjusted rate ratio [95% confidence interval]: inpatient visits, 6.26 [5.26, 7.46]; outpatient visits, 1.17 [1.16, 1.19]; emergency department visits, 2.11 [1.98, 2.25]; all p < 0.001). Patients with EoG/EoN incurred significantly higher costs versus patients without EoG/EoN (adjusted mean cost difference $31,180; p < 0.001). Cost differences were largely due to outpatient (adjusted mean cost difference $14,018; p < 0.001) and inpatient (adjusted mean cost difference $11,224; p < 0.001) costs.ConclusionThe economic burden associated with EoG/EoN is substantial, with patients with EoG/EoN having a higher rate of HRU and incurring $31,180 more than patients without EoG/EoN on average. Most of the cost difference was attributable to outpatient and inpatient costs. Cost-saving strategies to lower the burden of illness in this patient population are needed.

The healthcare resource utilization and costs of chronic lung allograft dysfunction following lung transplantation in patients with commercial insurance in the United States

Aims Chronic lung allograft dysfunction (CLAD), a common complication of lung transplantation, is the leading cause of death for lung transplant recipients. While data on lung transplant costs are available, the impact of CLAD on healthcare resource use (HRU) and cost is not well understood. The primary objective was to quantify the HRU and costs of CLAD in the US using real-world data. Methods A longitudinal retrospective analysis was performed of commercial claims data from the IQVIA PharMetrics Plus database for patients aged 18–64 who underwent lung transplantation between January 1, 2006 and September 30, 2018. Lung transplantation was identified using International Classification of Disease and Common Procedure Terminology procedure codes. Patients studied were observable for at least 12 months before and after transplantation. Patients who developed CLAD were identified using novel, diagnosis codes for incident lung disease at least one year following transplantation. Descriptive analyses were conducted to assess the study’s outcomes prior to and following a CLAD diagnosis. All-cause HRU and costs, the study’s primary outcomes, leading up to and following CLAD diagnosis were calculated. Results Among 129 transplant patients who developed CLAD, healthcare costs were substantially higher in the year following diagnosis ($198,113), compared to the year leading to diagnosis ($85,276). Inpatient admissions were responsible for most costs in years 1 and 2 following diagnosis ($99,372 and $83,348 respectively). Drug costs were higher in the 12 months post-index, compared to the 12 months pre-index ($3,600 vs $2,527). Limitations Claims data do not include clinical data, have limits determining loss of follow-up, and do not provide granularity to determine disease severity. Also, there is no ICD-10-CM code specific to CLAD or BOS. Conclusions CLAD after lung transplant is associated with substantial HRU and costs. Further work is needed to develop interventions that reduce this impact.

POSA107 Apixaban Versus Other Anticoagulants in the Prevention of Stroke and Systemic Embolism in Patients with Non-Valvular Atrial Fibrillation: A Comparison of All-Cause and Event-Related Costs in Real-Life Setting in France

To estimate and compare costs associated with all-cause healthcare resource use (HCRU), stroke/systemic embolism (SE) and major bleedings (MB) between patients with non-valvular atrial fibrillation (NVAF) initiating apixaban and patients initiating other oral anticoagulants (OAC).