Per-patient Per-month Health Care Costs Research Articles

Long-Term Temporal Trends of Real-World Healthcare Costs Associated with Nivolumab Plus Ipilimumab and Pembrolizumab Plus Axitinib as First-Line Treatment for Advanced or Metastatic Renal Cell Carcinoma.

Nivolumab plus ipilimumab (NIVO + IPI) and pembrolizumab plus axitinib (PEM + AXI) are first-line (1L) treatments for advanced or metastatic renal cell carcinoma (aRCC), although the long-term trends in their associated real-world healthcare costs are not well defined. We compared the real-world healthcare costs of patients with aRCC who received 1L NIVO + IPI or PEM + AXI over 24months. Adults with RCC and secondary malignancy who initiated 1L NIVO + IPI or PEM + AXI were identified in the Merative MarketScan Commercial and Medicare Supplemental Databases (01/01/2004 to 09/30/2021). All-cause and RCC-related healthcare costs (unadjusted and adjusted) were assessed per patient per month (PPPM) at 6-month intervals post-treatment initiation (index date) up to 24months, and differences between the NIVO + IPI and PEM + AXI cohorts were compared. Of 325 patients with aRCC, 219 received NIVO + IPI and 106 received PEM + AXI as the 1L treatment. According to patients' follow-up length, the analyses for months7-12 included 210 patients in the NIVO + IPI cohort and 103 in the PEM + AXI cohort; months13-18 included 119 and 48 patients, respectively; and months19-24 included 81 and 25 patients. PPPM unadjusted all-cause total costs were $46,348 for NIVO + IPI and $38,097 for PEM + AXI in months1-6; $26,840 versus $27,983, respectively, in months7-12; $22,899 versus $25,137 in months13-18; and $22,279 versus $27,947 in months19-24. PPPM unadjusted RCC-related costs were $44,059 for NIVO + IPI and $36,456 for PEM + AXI in months1-6; $25,144 versus $26,692, respectively, in months7-12; $21,645 versus $23,709 in months13-18; and $20,486 versus $25,515 in months19-24. PPPM costs declined more rapidly for patients receiving NIVO + IPI compared to those receiving PEM + AXI, resulting in significantly lower all-cause costs associated with NIVO + IPI during months19-24 (difference - $10,914 [95% confidence interval - $21,436, - $1091]) and RCC-related costs during months7-12 (- $4747 [(- $8929, - $512]) and 19-24 (- $10,261 [- $20,842, - $421]) after adjustment. Cost savings for NIVO + IPI versus PEM + AXI were driven by differences in drug costs which, after adjustment, were significantly lower in months7-12 (difference - $5555 [all-cause], - $5689 [RCC-related]); 13-18 (- $7217 and - $6870, respectively); and 19-24 (- $16,682 and - $16,125). Although the real-world PPPM healthcare costs of 1L NIVO + IPI were higher compared with PEM + AXI in the first 6months of treatment, the costs associated with NIVO + IPI rapidly declined thereafter, resulting in significantly lower costs vs. PEM + AXI from months7 to 24.

Total cost of care of Medicare Advantage beneficiaries participating in an appointment-based model in a national pharmacy chain.

The appointment-based model (ABM) is a pharmacy service to improve medication-related health outcomes. ABM involves medication synchronization and medication review, plus other services such as medication reconciliation, medication therapy management, vaccine administration, and multimedication packaging. ABM can improve medication adherence, but the economic impact is unknown. To assess the effect of a national pharmacy chain's ABM program for Medicare Advantage beneficiaries on total cost of care (TCOC). This study analyzed administrative claims data from April 7, 2017, through February 29, 2020, for Medicare Advantage beneficiaries with Part D using a propensity score-matched cohort design. The national pharmacy chain provided a list of ABM participants. Eligibility criteria for the ABM and control (non-ABM) groups included age 65 years or older on the index date (initial participation, ABM; random fill date, control) and continuous enrollment from at least 6 months pre-index (baseline) date through at least 6 months post-index (follow-up) date. Medical inflation-adjusted (2020) TCOC was calculated as the sum of all health care spending from Medicare Advantage beneficiaries with Part D plan and patient paid amounts, standardized to per patient per month (PPPM), during the follow-up period. Secondary outcomes included medication adherence calculated across prevalent maintenance therapeutic classes using proportion of days covered (PDC). Each group contained 5,225 patients with balanced characteristics after matching: 64% female, 73% White, mean age 75 years, mean Quan-Charlson comorbidity index score 0.9, and hypertension and dyslipidemia, each >65%. Median baseline all-cause PPPM health care costs in the ABM and control groups, respectively, were $517 and $548 ($221 and $234 medical, $135 and $164 pharmacy). Baseline PDC of at least 80% was 83% in the ABM group and, similarly, 84% in the control group. The mean (SD) follow-up was 604 (155) days for the ABM group and 598 (151) days for the control group. During the follow-up period, the median PPPM TCOC for the ABM group was $656 and was $723 for the control group (P = 0.011). Median pharmacy costs were also significantly less in the ABM group ($161 vs $193, P < 0.001), whereas median medical costs were $328 in the ABM group and $358 among controls (P = 0.254). More patients in the ABM group were adherent during follow-up, with 84% achieving PDC of at least 80% vs 82% among controls (P = 0.009). The ABM program was associated with significantly lower follow-up median total costs (medical and pharmacy), driven primarily by pharmacy costs. More patients were adherent in the ABM program. Payers and pharmacies can use this evidence to assess ABM programs for their members.

Cost of disease progression among US patients with human epidermal growth factor receptor 2-positive metastatic breast cancer.

Aim: The objectives were to investigate the differences in per patient per month (PPPM) healthcare resource utilization (HCRU) and costs among commercially insured and Medicare Advantage patients with human epidermal growth factor receptor 2 positive (HER2+) metastatic breast cancer (mBC) who experience disease progression in 12months compared with those who don't investigate the impact of progression timing on cumulative healthcare costs. Patients & methods: This claims-based study included patients diagnosed with mBC between 1January 2013 and 30April 2020 and received HER2-targeted therapy. Patients were categorized as progressed or nonprogressed. For objective one, monthly HCRU and costs were assessed for up to two lines of therapy (LOTs). Data were summarized descriptively and compared using a generalized linear model (GLM). For objective two, patients with at least 6 months of follow-up were assessed and cumulative healthcare costs were estimated in the 3 years following the start of LOT1 or LOT2 using a GLM and Kaplan-Meier weighting. Results: Among the 4113 patients in the study sample, 3406 had at least 12 months of follow-up (or less if due to death). Compared with nonprogressed patients, progressed patients had higher mean PPPM healthcare costs (LOT1: $22,014 vs $18,372, p<0.001; LOT2: $19,643 vs $16,863, p=0.001), and HCRU, including number of emergency room visits and inpatient stays (both p<0.001) in the 12 months following LOT start. Progressed patients had higher 3-year mean cumulative healthcare costs than nonprogressed patients following LOT1 and LOT2 and this difference was greater for patients who progressed earlier. Conclusion: Disease progression was associated with significant increases in HCRU and costs. Delays in progression were associated with lower cumulative healthcare costs. Earlier use of more clinically effective treatments to delay progression may reduce the economic burden among these patients.

Health Care Utilization and Costs Associated With Systemic First-Line Metastatic Melanoma Therapies in the United States.

US Food and Drug Administration approvals of immune checkpoint inhibitors and targeted therapies revolutionized the treatment of metastatic melanoma. Our aim was to assess health care resource utilization and costs for patients with metastatic melanoma treated with systemic therapies in first line between January 2012 and December 2017. We conducted a retrospective cohort study of patients with metastatic melanoma using MarketScan data. We included patients diagnosed with melanoma and secondary malignant neoplasm who used pembrolizumab, nivolumab, ipilimumab, ipilimumab plus nivolumab, BRAF-inhibitor (BRAF-i) plus MEK inhibitor (MEK-i), BRAF-i or MEK-i monotherapy, or chemotherapy in first line. We compared health care utilization and costs per patient per month (PPPM) using two-part and generalized linear models. We identified 1,870 patients, including 185 pembrolizumab, 103 nivolumab, 689 ipilimumab, 185 nivolumab plus ipilimumab, 214 BRAF-i plus MEK-i, 240 BRAF-i or MEK-i monotherapy, and 254 chemotherapy users. Highest PPPM rates of hospitalizations, emergency room visits, and outpatient visits were observed in patients with ipilimumab plus nivolumab therapy (adjusted difference v pembrolizumab [aDiff], 0.18, 0.12, and 0.88, respectively; all P < .001). Ipilimumab monotherapy users (aDiff, 0.07 and 0.93; all P < .001) and chemotherapy users (aDiff, 0.10 and 2.63; all P < .001) showed higher PPPM rates of hospitalizations and outpatient visits compared with pembrolizumab users, respectively. Utilization rates in nivolumab, BRAF-i plus MEK-i, and BRAF-i or MEK-i groups were similar to the pembrolizumab group. Highest PPPM total costs and drug-related costs were observed in the ipilimumab group ($80,139 US dollars [USD] and $70,051 USD; all P < .001), followed by the ipilimumab plus nivolumab ($71,689 USD and $56,217 USD; all P < .001) and the BRAF-i plus MEK-i group ($31,184 USD and $19,648 USD; all P < .001). PPPM costs in the nivolumab group were similar to the pembrolizumab group. Significant differences in health care resource utilization and costs were found across first-line metastatic melanoma regimens. Utilization rates were highest in patients using ipilimumab-containing therapies. High drug costs constituted a major fraction of total PPPM health care costs.

Economic Burden of Newly Diagnosed Acute Myeloid Leukemia: A Retrospective Study Using the SEER-Medicare Database

Economic Burden of Newly Diagnosed Acute Myeloid Leukemia: A Retrospective Study Using the SEER-Medicare Database

Health Care Resource Utilization and Cost Before Initial Schizophrenia Diagnosis.

The management of schizophrenia, a chronic, multifaceted mental health condition, is associated with considerable health care resource utilization (HCRU) and costs. Current evidence indicates that a high-risk and costly prodromal period, during which patients are likely symptomatic, precedes diagnosis. Better characterization and disease management during this stage could help to improve patient outcomes. To describe and compare HCRU and costs for up to 5 years before diagnosis in a cohort with schizophrenia versus a demographically matched cohort without schizophrenia in a commercially insured U.S. This retrospective study identified newly diagnosed schizophrenia patients using enrollee claims in the HealthCore Integrated Research Database between January 1, 2007, and April 30, 2016. The index date was defined as the date of the first medical claim with a schizophrenia diagnosis code. Schizophrenia patients were directly matched (1:4) by age, sex, and region to comparators without schizophrenia who were assigned the same index dates as their matched schizophrenia counterparts. Observation periods were 0-12, 13-24, 25-36, 37-48, and 49-60 months before the index date. Outcomes included HCRU and costs for inpatient admissions, emergency room visits, outpatient care (office visits and other outpatient services), and medications. Means, standard deviations, medians, and 95% confidence intervals were calculated for continuous variables; relative frequencies and percentages were calculated for categorical variables. Cohorts were compared with t-tests for continuous variables and chi-square tests for categorical variables. Differences across cohorts were estimated with individual generalized linear models for each observation period, controlling for gender, age, geographic region of residence, health plan type and subscriber status, behavioral pre-index comorbidities and chronic comorbidities during the period before diagnosis. 6,732 schizophrenia patients were matched to 26,928 patients without schizophrenia. All-cause inpatient admissions were more prevalent among schizophrenia patients than their comparators for all time periods (49-60 months prediagnosis: 9% vs. 4%; 0-12 months prediagnosis: 33% vs. 4%). The schizophrenia cohort had higher adjusted all-cause per-patient per-month health care costs relative to comparators from the earliest period of 49-60 months prediagnosis ($557 [95% CI = 474-639] vs. $321 [95% CI = 288-355]) through 0-12 months prediagnosis ($1,058 [95% CI = 998-1,115] vs. $338 [95% CI = 320-355]). Behavioral health-related costs were different in each time period as were cost ratios (schizophrenia costs: comparator costs), which increased from 5.4 in the earliest period to 14.8 in the year before diagnosis. Schizophrenia patients had higher all-cause and behavioral health-related HCRU and costs before diagnosis than matched controls. Costs increased from 5 years to 1 year prediagnosis for schizophrenia patients driven primarily by inpatient hospital stays and prescription drug costs, but remained stable for comparators. Additional research is needed for the development of predictive models to aid in the identification of high-risk patients. This study was sponsored by Boehringer Ingelheim Pharmaceuticals. Barron is an employee of HealthCore, which received funding from Boehringer Ingelheim to conduct this study. Wallace and York were employed by HealthCore at time of this study. Isenberg is an employee of Anthem. Franchino-Elder, Sidovar, and Sand are employees of Boehringer Ingelheim.

MP32-03 THE DIRECT AND INDIRECT COSTS DUE TO WORK LOSS ASSOCIATED WITH OVERACTIVE BLADDER IN THE UNITED STATES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures II1 Apr 2017MP32-03 THE DIRECT AND INDIRECT COSTS DUE TO WORK LOSS ASSOCIATED WITH OVERACTIVE BLADDER IN THE UNITED STATES Emily Durden, David Walker, Stephani Gray, Robert Fowler, Paul Juneau, and Katherine Gooch Emily DurdenEmily Durden More articles by this author , David WalkerDavid Walker More articles by this author , Stephani GrayStephani Gray More articles by this author , Robert FowlerRobert Fowler More articles by this author , Paul JuneauPaul Juneau More articles by this author , and Katherine GoochKatherine Gooch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.978AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of overactive bladder (OAB) on costs due to time lost from work is not well known. The objective of this study was to quantify the direct healthcare costs and indirect costs due to work loss associated with OAB in the United States (US). METHODS Adults ≥18 years of age with an OAB diagnosis or OAB prescription therapy between 1/1/2008 and 12/31/2013 were identified from the MarketScan® administrative claims databases (index date = qualifying claim date). Patients were required to have ≥12 months of pre- and ≥1 month of post-index continuous enrollment. Data on work loss due to absence and short-term disability (STD) were available for subsets of the overall study population. Each OAB cohort was propensity score-matched to an equivalent number of non-OAB controls. Estimates of total per-patient per-month (PPPM) direct healthcare costs, as well as estimates of indirect costs attributable to absence and STD were modeled using ordinary least squares regression. The level of statistical significance for all tests was set at 0.05. RESULTS 110,059 OAB patients were identified, 9.8% of whom had work absence data and 49.3% had STD data. Average adjusted PPPM healthcare costs were significantly higher among OAB patients than non-OAB matched controls ($3,003.42 vs. $1,122.80, p<0.0001). Similarly, among patients with STD eligibility, those with OAB incurred significantly higher PPPM indirect costs attributable to STD compared to non-OAB controls ($114.23 vs. $98.31, p=0.0192) when adjusted within the framework of a two-part model. PPPM indirect costs of work loss due to absence did not differ significantly between patients with OAB and non-OAB matched control patients ($1,412.27 vs. $1,350.56, p=0.4398). CONCLUSIONS Patients with OAB incurred 2.5 times the healthcare costs of patients without OAB. OAB patients incurred more work loss and costs due to STD than non-OAB controls. Indirect costs attributable to workplace absence, however, did not differ for OAB patients and non-OAB controls. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e409 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Emily Durden More articles by this author David Walker More articles by this author Stephani Gray More articles by this author Robert Fowler More articles by this author Paul Juneau More articles by this author Katherine Gooch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Does Hepatitis C Treatment Adherence Affect Risk of Liver Transplantation? A Historical Cohort Study.

Chronic hepatitis C virus (HCV) is the primary cause of liver failure leading to transplantation, and medication adherence is essential to the therapeutic efficacy of HCV treatments. While there is evidence linking poor adherence with increased utilization and cost, published literature lacks examination of the association between medication adherence and risk of liver transplant. In addition, the impact of HCV treatment on total costs of liver transplantation is not well documented. To compare (a) the relative risk of liver transplant by adherence in patients treated for HCV and (b) the total health care costs in treated and untreated patients who require liver transplant. This observational, historical cohort study was conducted using administrative data from the Humana Research Database. To be included, patients were required to have a documented HCV diagnosis or treatment between January 1, 2008, and June 30, 2013. Patients were excluded if they had a hepatitis B diagnosis, were not fully insured by a commercial or Medicare Advantage Prescription Drug plan, or were outside the age range of 19-89 years. No minimum pre- or post-index enrollment period was required, and patients were followed for their entire post-index enrollment through December 31, 2013. The study population was divided into treated and untreated groups and then subdivided by presence or absence of a liver transplant. Date of liver transplant was defined as the index date for untreated liver transplant patients; otherwise, the index date was defined as either the date of first observed HCV treatment or diagnosis date (if no treatment or liver transplant). Cox proportional hazards models were used to estimate the relative risk of liver transplant by level of treatment adherence (> 80%, 50%-79%, and < 50%) based on proportion of days covered. General linearized models with log link and gamma distribution were used to compare median total health care costs from index date until end of study period (or death/disenrollment, whichever came first) between treated and untreated liver transplant patients. All costs were converted to 2013 U.S. dollars and reported as total costs per patient and per patient per month (PPPM) to account for varying follow-up periods. Of the 53,423 patients identified with HCV, 10,377 met exclusion criteria, leaving 43,046 patients (primarily Caucasian, males, mean age of 58 years) in the initial cohort. Only 6.29% (n = 2,708) of the total HCV cohort received HCV treatment, and less than 1% (n = 366, 0.8%) received a liver transplant. Although there were no significant differences in the risk of liver transplant by adherence level, there was an upwards trend in the rate of liver transplant as adherence worsened (> 80%: 1.25%; 50%-79%: 1.30%; and < 50%: 1.99%), and the average days to liver transplant was longer with higher adherence (> 80%: 683; 50%-79%: 623; < 50%: 454). Only 48 (13.11%) patients who received a liver transplant were treated for HCV. Adjusted median total and PPPM health care costs measured from index date until end of the study period were significantly higher for patients who received HCV treatment compared with those who did not (total=$231,139 vs. $86,167, adjusted P < 0.001; PPPM=$20,583 vs. $5,778, adjusted P = 0.008), driven by HCV-related medical costs and total pharmacy costs. Adherence with HCV regimens did not affect risk of liver transplant, underscoring the need for further evidence linking treatment adherence to future liver transplant risk. HCV-treated patients who required liver transplant incurred significantly higher health care costs than those without HCV treatment before liver transplant. Introduction of newer all-oral direct-acting antiviral regimens, with higher acquisition costs, will require further research to more accurately assess medication adherence and its relationship with transplantation, as well as with total health care costs. No outside funding supported this research. Ems, Worley, Racsa, Gregory, Anderson, and Holt are employees of Humana. Brill has participated in a physician advisory board at Humana. The authors have no other financial disclosures to report. Study concept and design were contributed by Ems, Racsa, Worley, and Anderson, along with Gregory, Brill, and Holt. Racsa took the lead in data collection, along with Ems and Worley. All authors participated in data interpretation. Anderson, along with the other authors, wrote the manuscript, which was revised by Brill and Holt, with assistance from the other authors.

Real-world treatment patterns, health care resource utilization (HRU), and costs among patients with Waldenstrom macroglobulinemia (WM) initiating therapy.

17 Background: WM is a rare, indolent B-cell lymphoma with 1000 to 1500 new cases diagnosed annually in the US. The disease is incurable with current therapy. Prior to January 2015 when ibrutinib was approved by the US FDA for WM, there were no therapies approved in this indication. This study describes initial systemic anti-cancer therapy (SACT) and HRU among WM patients (pts). Methods: A retrospective study using a large, national US claims database from 1/2007-10/2013 was conducted. Adult WM pts ( ≥ 2 claims for WM) with ≥ 1 claim for SACT were identified; the first SACT claim date was the index date. Pts were required to have a WM diagnosis within 3 months (m) prior to the index date and be continuously enrolled (CE) in the health plan for 12m pre- and ≥ 6m post-index date. Pregnant pts and those with SACT in the pre-index period were excluded. The first line of therapy (LOT1) period was examined; the LOT started at index date and the regimen included all drugs received within 60 days. The LOT ended at the earliest of, start of a new drug, ≥ 60-day gap in receipt of initial drug regimen, death or CE end. All-cause HRU and costs during LOT1 were examined. Results: There were 161 WM pts identified. 66% of pts were ≥ 65 yrs (mean age 69), 55% were male, and by insurance type, 49% were Medicare Advantage pts vs. 51% commercially insured. Mean total follow-up time was 23m, and mean duration of LOT1 was 4.7m. The top 4 most common LOT1 regimens accounted for 71% of patients: Rituximab (R) only (39%); bortezomib+ R (14%); bendamustine+ R (9%) and cyclophosphamide+ R (9%). No other regimens identified accounted for more than 4% of pts. Overall, 96% and 81% of pts had ≥ 1 office or hospital outpatient visit with mean per patient per month (PPPM) visits of 3.55 (standard deviation, SD = 2.41) and 2.60 (SD = 3.06), respectively. Approximately 25% and 21% had ≥ 1 ER visit or inpatient stay with mean PPPM visits of 0.11 (SD = 0.24) and 0.06 (SD = 0.16), respectively. Total mean PPPM healthcare costs during LOT1 was $13,589 (SD = $13,404). Conclusions: HRU and costs were high among WM pts initiating SACT. Future studies should examine whether differences in LOT1 regimen choice are associated with differences in cost and outcomes.

Healthcare Resource Utilization and Costs Associated with Autosomal Dominant Polycystic Kidney Disease.

Background: Autosomal dominant polycystic kidney disease (ADPKD), a hereditary nephropathy, eventually leads to end-stage renal disease (ESRD), typically by mid-life. Objectives: The objective of this study was to assess real-world healthcare resource utilization and cost among commercially insured (COM) and Medicare Advantage (MAPD) ADPKD patients in addition to the cost profile by chronic kidney disease (CKD) stage. Methods: Patients diagnosed with ADPKD (two or more claims) with ≥30 days of continuous medical and pharmacy benefits and no evidence of autosomal recessive polycystic kidney disease were selected (Optum Research Database and Impact National Benchmarking Database: 1/1/06-8/31/12). Plan and patient paid healthcare costs and resource utilization per patient per month (PPPM) were described in total and by insurance type. CKD stage was established based on serum creatinine laboratory values or dialysis-related codes. Adjusted, CKD stage-specific costs were predicted for 4 years using regression models. Results: Of the 36,253,096 patients in the databases (1/1/06-8/31/12), 5,051 had evidence of ADPKD. Following exclusion criteria, 4,356 COM and 468 MAPD ADPKD patients remained. Total healthcare resource utilization and costs were high, and costs increased substantially from CKD stage 1-5. PPPM healthcare costs were 37% for ADPKD management and 52% for dialysis services. Predicted 4-year healthcare costs by CKD stage were $40,164 (stage 1), $33,397 (stage 2), $42,686 (stage 3), $148,402 (stage 4), and $207,548 (stage 5). Conclusions: Healthcare resource utilization and costs associated with ADPKD were substantial, irrespective of payer type, and primarily driven by CKD stage. Of the total healthcare costs, 88% were ADPKD- and dialysis-related. Most impactful was the spike in predicted cost when patients progressed from CKD stage 3 to stage 4 (by 348%) after multivariate adjustment. These stage 4-associated costs are primarily due to ultimate progression into stage 5 and ESRD within the 4-year time frame.

Are There Differences in Patient Characteristics, Treatment Patterns and Costs by Treatment Setting?

AbstractAbstract 4259 Background:Few studies have examined whether differences in treatment and outcomes exist among cancer patients by the setting where care is delivered. This study investigates differences in treatment patterns, health care resource use and costs among non-Hodgkin's Lymphoma (NHL) and Chronic Lymphocytic Leukemia (CLL) patients receiving rituximab (R) or R+ chemotherapy based on site of care: office/clinic (OC) vs. hospital outpatient (HOSP). Methods:Patients ≥18 years with evidence of NHL or CLL diagnoses codes at least 30 days apart and received ≥2 R claims from Jan 2007 to Mar 2011 were identified from a large US commercial insurance claims database. Patients were required to be enrolled in the health plan for at least 6 months before and after the index date (date of first R claim). The follow-up period was the date of the first infusion to 30 days after the last infusion prior to a gap of ≥7 months. Patients with evidence of multiple cancers or receipt of R at both sites of care were excluded. Cohorts were created based on site of care where R was administered and type of insurance, commercial (COM) vs. Medicare Advantage (MA). Descriptive analyses were conducted to examine differences in treatment patterns and per-patient per-month (PPPM) health care costs. Multivariate analyses adjusting for age, gender, baseline Charlson index score and receipt of monotherapy was also conducted to examine differences in PPPM health care costs. Results:A total of 2,594 OC and 286 HOSP patients were identified. A higher percentage of Medicare Advantage patients (27% of 878 patients, n=236) received Rituxan therapy in the HOSP setting compared to commercially insured patients (2% of 2002 patients, n=50).Among the Medicare Advantage patients, age, gender, and baseline Charlson comorbidity index were not significantly different by cohort. The mean length of the episode of care was not significantly different by site of service but the number of Rituxan infusions (5.4 vs. 6.8, p<0.01) and infusions/mth (0.99 vs. 1.27, p<0.01) were significantly less in the HOSP compared to the OC. Incidence rates of ER visits (0.11 vs. 0.08, p=0.02), but not hospitalizations were higher among the HOSP cohort. Unadjusted infusion day costs were higher among the HOSP compared to the OC ($6,479 vs. $4,998, p<0.01) but total PPPM costs were not significantly different by cohort ($9,323 vs. $10,051, p>0.05). In multivariate analyses, total PPPM costs were slightly less among the HOSP cohort (cost ratio=0.92, p<0.01).Among the commercially insured population, gender and baseline Charlson comorbidity index were not significantly different by cohort though patients in the HOSP were slightly younger than those in the OC (55 years vs. 59 years). The mean length of the episode of care was not significantly different by site of service but compared to the OC the number of Rituxan infusions (5.52 vs. 7.56, p<0.01) and infusions per month (1.05 vs. 1.17, p>0.05) were less in the HOSP though the difference in infusions/month was not significant. Incidence rates of ER visits and hospitalizations were also not significantly different. Unadjusted infusion day costs were higher among the HOSP cohort compared to the OC cohort ($10,939 vs. $5,464, p<0.01) as well as total PPPM costs ($17,230 vs. $11,549, p=0.01). In multivariate analyses, total PPPM costs remained significantly higher among the HOSP cohort (cost ratio=1.40, p<0.01). Conclusions:A lower percentage of COM patients receive Rituxan infusions in the HOSP setting compared to MA patients. However, regardless of insurance type, patients in the HOSP cohort incurred greater costs on the day of Rituxan infusion compared to the OC cohort. Among MA patients, although costs incurred on the day of infusions were significantly higher in the HOSP cohort, patients treated in the HOSP setting had slightly lower total PPPM costs likely due to fewer administrations per month of Rituxan during an episode of care. Among COM patients, higher infusion day costs contributed to higher total overall costs among the HOSP cohort. These results warrant further investigation to assess the impact of these differences on clinical outcomes by site of care. Disclosures:Dacosta Byfield:OptumInsight: Employment, OptumInsight received payment from Genentech to conduct the study described in the abstract Other. Reyes:Genentech, Inc.: Employment, Roche Stock Other. Becker:OptumInsight: Employment, OptumInsight received payment from Genentech to conduct the study described in the abstract Other. Small:Genentech, Inc: Employment, Roche stock Other.

Treatment Persistence with Azacitdine (Vidaza) Is Associated with Lower Inpatient Hospitalization Costs Over Time

Abstract 4231 Background:In the US, understanding the costs associated with Myelodysplastic Syndromes (MDS) is challenging given that multiple channels including pharmacy, ambulatory, and inpatient hospitalization (IPH) settings make up the total expenses to manage patients. Recent studies suggest that MDS patients under active medical management experience fewer cytopenia-related medical problems compared to untreated, transfusion dependent (TD) patients who require more medical treatments, often for recurrent infections and bleeding complications. It is clear that persistence of drug therapy is essential to achieve optimal clinical responses for MDS patients and we sought to determine if continued therapy also optimized costs related to the disease. Aim:To evaluate the relationship between treatment persistence with AZA and health care costs encountered for patients with MDS. Methods:Commercial and Medicare Advantage enrollees with a diagnosis of high grade MDS (ICD-9, 238.73) who initiated AZA with pharmacy and medical benefits in the prior 6 months and who had a variable follow up period from initiation of AZA to disenrollment or end of study were identified in a US health plan claims database (1/1/2007-6/30/2010). The number of AZA “cycles” was calculated by dividing the total number of AZA administrations by 7 days, with a sensitivity analysis for 5 day administration, - commonly utilized in the “real-world”. Persistence was defined as the number of cycles of AZA. Eligible patientshad to have at least 2 AZA cycles. An independent analysis identified health care costs for the same patients during periods of transfusion-dependence (TD) - defined as periods in which they received 2 transfusions in an 8 week period and did not receive erythropoietin-stimulating agents (ESAs) or AZA. Average Per Patient Per Month (PPPM) costs were examined among patients with various lengths of TD periods, up to 1 year. Linear models were used to examine the relationship between persistence on AZA and PPPM health care costs. Healthcare costs included both payer and patient paid amounts under the medical and pharmacy benefit. Medical costs were further broken out into IPHs, ambulatory, and other costs captured. Several sensitivity analyses were performed to confirm the robustness of the results such as excluding patients with IPH prior to AZA initiation, and including patients with <2 cycles of AZA. Results:The baseline cost breakdown for MDS patients (n=225) who were transfusion dependent and not receiving treatment are outlined in Figure 1. Interestingly, the largest proportion of the medical costs for TD patients comes from IPHs. In fact, the PPPM IPH costs among TD periods account for approximately 65–75% of total health care costs - even at one year of their diagnosis. A similar analysis was done for patients completing at least 2 cycles of AZA (n = 100) which suggested that the proportion of cost related to IPHs was closer to 40%. This cohort averaged 6.3 cycles (median = 5) with 24% of patients completing at least 8 cycles. Importantly, completion of every additional AZA cycle (baseline 7day analysis) was found to be associated with, on average, a 6% decrease in medical care costs (p=0.005) driven largely by an 18% decrease in IPH costs (p<0.001; Figure 2) due to fewer medical events. Even a single additional AZA cycle was found to be associated with 5% lower total health care cost (p=0.006). These results also hold in the sensitivity analyses. As expected, an examination of medical needs of both TD and AZA treated patients led infections as a frequent driver of IPHs. Conclusions:Patients who persist with AZA therapy have lower PPPM medical costs, driven by decreased expenditures on IPHs. This is consistent with results identified in the AZA-001 clinical trial in which patients receiving AZA experienced reduced IPHs driven by less transfusions and need for IV antibiotics, antifungals, and antivirals. These lower overall costs offset the expected increase in continuing therapy based on the cost of drug alone. Improving duration of therapy of AZA may not only optimize clinical outcomes but may decrease cumulative costs of care among high risk MDS patients. [Display omitted] [Display omitted] Disclosures:Smith:Celgene: Consultancy. Mahmoud:celgene: Employment. Dacosta Byfield:Celgene: Consultancy. Henk:Celgene: Consultancy.

The burden of metastatic melanoma (mM): Treatment patterns, healthcare use, and costs.

8565 Background: Treatment (tx) of mM with currently available therapies is often of limited clinical benefit, with infrequent durable responses and relatively low survival. Few studies have examined health care utilization (HCU), costs and treatment patterns of the disease. Methods: A claims-based analysis was conducted using data from 1/2007 to 3/2010 from a national commercial health insurer. Patients (pts) included were ≥18 yrs, had ≥ 2 claims for metastatic disease (ICD-9-CM 196.xx-198.xx) ≥ 30 days apart, and ≥ 2 claims for melanoma (ICD-9-CM 172.xx) ≥ 30 days apart or ≥ 1 claim for cancer-related tx with a dx of melanoma. The index date was the first mM dx date; those with a 2nd primary cancer were excluded. Pts were continuously enrolled for 6 mo prior (baseline) and ≥ 3 mo after the index date (follow-up). Treatment patterns, total HCU, average per-patient per-month (PPPM) costs, best supportive care (BSC) - defined as hospice after the end of systemic therapy - and mortality were examined. Results: The study included 829 mM pts with a mean age of 58.8 yrs, mean baseline comorbidity index of 3.42 and most (65%) were male. Throughout the study period, 71% and 10% of pts had evidence of immunohistochemistry and molecular testing, respectively. Only 431 (52%) and 103 (12%) had evidence of starting 1st-line and 2nd-line tx respectively. Most (50%) were treated with single-agent temozolomide or interferon alfa. The rate of HCU (events/person-yr) increased 1.5-5 fold from baseline to follow-up (p<0.01); 0.28 vs. 1.40 for inpatient, 19.11 vs. 29.64 for office visits, 12.03 vs. 26.86 for outpatient visits and 0.96 vs. 1.45 for ER visits. Mean PPPM health care costs increased from $1,855 at baseline to $9,495 during follow-up (p-value <0.01). Among the entire study cohort, 173 (20.9%) had evidence of BSC and 289 (34.7%) died. Among those who died, mean survival time was 285 days. Conclusions: Resource utilization and cost increase considerably after development of metastases in pts with melanoma. The low proportion of patients with 1st- or 2nd-line tx suggest frequent enrollment in clinical trials as an early or intervening tx. More effective tx, like those targeting relevant biomarkers, are needed to improve outcomes and reduce the burden of mM.