Per Patient Per Month Research Articles

Economic Burden of Recurrence Among Resected Medicare Patients With Early Stage NSCLC

IntroductionPatients with early NSCLC (eNSCLC) who experience recurrence are associated with worse survival outcomes, but the economic burden of recurrence is not well characterized. This study evaluated the incremental health care resource utilization and costs of recurrence in Medicare patients with resected eNSCLC. MethodsThis retrospective observational study used Surveillance, Epidemiology, and End Results cancer registry data linked with Medicare claims. Eligible patients were 65 years and older with newly diagnosed NSCLC stages IB to IIIA (American Joint Committee on Cancer Staging Manual, seventh edition) and surgery between January 2010 and December 2017. Continuous enrollment criteria were applied to ensure appropriate data capture. Per patient per month (PPPM) health care resource utilization and all-cause direct costs were compared for patients with versus without recurrence, which was identified from claims data using diagnosis, procedure, or drug codes. Patients were matched (1:1) using exact matching on cancer stage and treatment, and propensity score matching on other characteristics. ResultsIn total, 2035 (44%) out of 4595 patients had evidence of recurrence. After matching, 1494 patients were included in each cohort. Patients with recurrence had a significantly higher number of inpatient visits (+0.25 PPPM), outpatient visits (+1.10 PPPM), physician services (+3.70 PPPM), and emergency department (ED) visits (+0.25 PPPM; all p < 0.001). The average follow-up PPPM cost in the recurrence cohort was U.S. dollars $7437 and $1118 in the no-recurrence cohort, resulting in a difference of $6319 PPPM (p < 0.001) with inpatient costs as the largest contributor. ConclusionsOn the basis of a real-world population, the recurrence among patients with resected eNSCLC is associated with increased health care resource utilization and costs.

Real-world treatment patterns and healthcare costs in patients with psoriasis taking systemic oral or biologic therapies

BackgroundPsoriasis is a chronic, immune-mediated, systemic inflammatory disorder associated with high costs. This study evaluated real-world treatment patterns and associated costs in patients in the United States with psoriasis initiating systemic oral or biologic treatments.MethodsThis retrospective cohort study used IBM® (now Merative™) MarketScan® Commercial and Medicare claims (1 January 2006–31 December 2019) to evaluate patterns of switching, discontinuation, and nonswitching in two cohorts of patients initiating oral or biologic systemic therapy. Total pre-switch and post-switch costs were reported per-patient per-month (PPPM).ResultsEach cohort was analyzed (oral, n = 11,993; biologic; n = 9753). Among the oral and biologic cohorts, 32% and 15% discontinued index and any systemic treatment within 1 year of initiation; 40% and 62% remained on index therapy; and 28% and 23% switched treatment, respectively. In the oral and biologic cohorts, total PPPM costs within 1 year of initiation for nonswitchers, patients who discontinued, and patients who switched were $2594, $1402, and $3956, respectively, and $5035, $3112, and $5833, respectively.ConclusionThis study identified lower persistence in the oral treatment cohort, higher costs associated with switching, and a need for safe and effective oral treatment options for patients with psoriasis to delay the switch to biologic therapy.

Real-world impact of empagliflozin on total cost of care in adults with type 2 diabetes: Results from an outcomes-based agreement.

BACKGROUND: Value-based health care is expanding through payment models such as outcomes-based agreements between manufacturers and payers. OBJECTIVE: To describe the total-cost-of-care outcomes of an outcomes-based agreement evaluating the real-world impact of empagliflozin vs other type 2 diabetes mellitus (T2DM) drugs among all patients with T2DM, with and without cardiovascular disease (within and beyond the requirement of the agreement). METHODS: In this prospective real-world analysis, members from the health plan of an integrated health care delivery system from the commercial and Medicare Advantage lines of business, who qualify under the confines of the contract, were included for analysis. Thus, members aged 18 years and older who were continuously enrolled in the identification (January 1, 2018, to December 31, 2018) and measurement periods (≤1 year post-index) with a T2DM diagnosis were retained. Patients using empagliflozin and empagliflozin-combination drugs constituted the empagliflozin group; those using all other antihyperglycemics, the nonempagliflozin group. Patients with type 1 diabetes, or those using metformin or insulin monotherapy, at index were excluded. Eligible members were followed for up to the earliest occurrence of disenrollment date, discontinuation (60-day medication fill gap allowed) of empagliflozin (or nonempagliflozin containing) medication, or the end of the measurement period. We compared, using Student's t-test and summary statistics (for reporting the outcomes agreement) and a propensity-matched difference-in-difference model (for the followup evaluation beyond the requirement of the agreement), the mean all-cause total cost of care (pharmacy plus medical) per patient per month (PPPM) between the 2 groups, including a subgroup of members with a baseline cardiovascular disease diagnosis. RESULTS: There were 4,577 (3,069 and 1,508 in the commercial and Medicare) and 33,712 (15,571 and 18,141 in the commercial and Medicare) in the empagliflozin and nonempagliflozin groups, respectively. The difference in mean total cost PPPM was $75 lower for empagliflozin vs nonempagliflozin groups, driven mainly by lower medical costs in the empagliflozin group (-$465 PPPM). However, the difference was not statistically significant in the propensity score-matched model. CONCLUSIONS: Although empagliflozin had higher pharmacy costs, the total cost of care for patients with T2DM and with established cardiovascular disease were comparable to the group of patients with all other T2DM, driven mainly by lower medical costs. DISCLOSURES: The authors report no conflicts of interest beyond being employees of the 2 organizations involved in this outcomes-based agreement. Ms. Palli is a former employee of Boehringer Ingelheim Pharmaceuticals, Inc., who was affiliated at the time of study conduct.

Patterns of pancreatic enzyme replacement therapy (PERT) use among U.S. patients with pancreatic cancer.

696 Background: PERT is an important but costly and inconsistently used supportive care medication in PC. We sought to characterize patterns of PERT use among U.S. insured patients with PC. Methods: We conducted a retrospective observational analysis of patients with a primary diagnosis of pancreatic adenocarcinoma in the IBM MarketScan national claims database between 2013-2019. We identified pharmacy claims for PERT (Creon, Pancreaze, Pertzye, Viokace, and Zenpep) and classified patients as PERT-users (≥ 1 PERT prescription [Rx]) and non-PERT users. We used descriptive statistics for clinical, demographics, and costs. Multiple logistic regression identified predictors of PERT use. Kaplan-Meier method assessed time from PC diagnosis to first PERT Rx. Results: Of 19,866 patients with PC (median age 62 years, 49% women), 6,918 (35%) were PERT-users. The median follow-up was 11 months (PERT users: 14 months, non-PERT users: 9 months). Overall, 43% of patients received no cancer-directed treatment. PERT-users were more likely to have a history of pancreatitis (acute, odds ratio [OR] = 1.9; chronic, OR = 3.6), and received chemotherapy (OR = 1.2), surgery (OR = 2.3), and radiation (OR = 1.4). Among all PERT-users, the median time from PC diagnosis to first fill was 1.9 months (95% CI: 1.8,2.0). The median time from surgery to first fill was 1.6 months (95% CI: 1.4,1.7). The median number of PERT Rxs was 4; 22% of PERT-users received 1 Rx. A median of 150 days of PERT was supplied across all Rxs per patient. The median (IQR) cost of each PERT Rx was $25 ($0- $50). PERT accounted for 16% of all drug out-of-pocket costs (OOPC) (excluding systemic outpatient cancer-directed treatment), and 7% of all healthcare OOPC. Patients with PERT had significantly higher monthly OOPC on Rxs but lower on all other services, including inpatient and outpatient services (all p &lt; 0.0001). Overall, PERT-users had significantly lower per-patient per-month (PPPM) OOPC vs non-PERT users ($469, vs $520, p &lt; 0.0001). They also had fewer PPPM outpatient (0.7 vs 1.2, p &lt; 0.0001) and ER (0.4 vs 0.5, p &lt; 0.0001) visits. Conclusions: In this national study of insured U.S. adults with PC, only one-third received PERT. Of those receiving PERT, approximately a fifth received just a single Rx. PERT users, despite higher OOP drug spending had reduced overall OOP costs and fewer healthcare visits. These data highlight the need to explore non cost-related reasons for lack of and ways to standardize PERT use.

Economic Burden of HIV in a Commercially Insured Population in the United States.

Background: With advances in antiretroviral therapy (ART), people with HIV infection are living longer. Pre-exposure prophylaxis (PrEP) to reduce HIV infection risk continues to be underutilized in high-risk individuals. Recent data on economic burden for patients with newly diagnosed HIV-1 or initiated with PrEP are limited. Objectives: To assess characteristics, healthcare resource utilization (HRU), and costs among adults and adolescents either with newly diagnosed HIV-1 or initiated with PrEP. Methods: This retrospective observational study utilized data from the IBM MarketScan® Commercial Claims and Encounters database. Adults with newly diagnosed HIV-1 or those initiated with PrEP were included (index date was the first HIV diagnosis or PrEP prescription, respectively, between January 1, 2016, and April 30, 2021). Corresponding cohorts of adolescents were considered exploratory. Descriptive analyses were conducted to assess baseline demographics and clinical characteristics, and all-cause and HIV-related HRU and costs per patient per month (PPPM) during follow-up. Results: Data from 18 154 adults and 220 adolescents with newly diagnosed HIV and 34 123 adults and 175 adolescents initiated with PrEP were included. Approximately 70% of adolescents and 9% of adults receiving PrEP were female. Baseline depression/anxiety was present in 16.1% and 24.6% of adults and 14.5% and 45.1% of adolescents in the HIV and PrEP cohorts, respectively. Substance abuse in the HIV and PrEP cohorts, respectively, was reported in 10.1% and 7.0% of adults, and 2.7% and 17.7% of adolescents. During follow-up, among adults with newly diagnosed HIV, mean (SD) total all-cause and HIV-related PPPM costs were $2657 ($5954) and $1497 ($4463), respectively; pharmacy costs represented 47% of all-cause costs and 67% of HIV-related costs, but only 37% of patients had an HIV-related prescription. All-cause costs PPPM for adults with PrEP were $1761 ($1938), with pharmacy costs accounting for 71%. Conclusions: Despite advances in ART, patients with newly diagnosed HIV and at-risk patients receiving PrEP continue to incur HRU costs. The chronic nature of HIV warrants further exploration of factors contributing to disease burden and opportunities to improve prevention strategies.

Economic Burden of HIV in a Commercially Insured Population in the United States

Background: With advances in antiretroviral therapy (ART), people with HIV infection are living longer. Pre-exposure prophylaxis (PrEP) to reduce HIV infection risk continues to be underutilized in high-risk individuals. Recent data on economic burden for patients with newly diagnosed HIV-1 or initiated with PrEP are limited. Objectives: To assess characteristics, healthcare resource utilization (HRU), and costs among adults and adolescents either with newly diagnosed HIV-1 or initiated with PrEP. Methods: This retrospective observational study utilized data from the IBM MarketScan® Commercial Claims and Encounters database. Adults with newly diagnosed HIV-1 or those initiated with PrEP were included (index date was the first HIV diagnosis or PrEP prescription, respectively, between January 1, 2016, and April 30, 2021). Corresponding cohorts of adolescents were considered exploratory. Descriptive analyses were conducted to assess baseline demographics and clinical characteristics, and all-cause and HIV-related HRU and costs per patient per month (PPPM) during follow-up. Results: Data from 18 154 adults and 220 adolescents with newly diagnosed HIV and 34 123 adults and 175 adolescents initiated with PrEP were included. Approximately 70% of adolescents and 9% of adults receiving PrEP were female. Baseline depression/anxiety was present in 16.1% and 24.6% of adults and 14.5% and 45.1% of adolescents in the HIV and PrEP cohorts, respectively. Substance abuse in the HIV and PrEP cohorts, respectively, was reported in 10.1% and 7.0% of adults, and 2.7% and 17.7% of adolescents. During follow-up, among adults with newly diagnosed HIV, mean (SD) total all-cause and HIV-related PPPM costs were $2657 ($5954) and $1497 ($4463), respectively; pharmacy costs represented 47% of all-cause costs and 67% of HIV-related costs, but only 37% of patients had an HIV-related prescription. All-cause costs PPPM for adults with PrEP were $1761 ($1938), with pharmacy costs accounting for 71%. Conclusions: Despite advances in ART, patients with newly diagnosed HIV and at-risk patients receiving PrEP continue to incur HRU costs. The chronic nature of HIV warrants further exploration of factors contributing to disease burden and opportunities to improve prevention strategies.

Healthcare Resource Utilization and Associated Costs of German Patients with Diffuse Large B-Cell Lymphoma: A Retrospective Health Claims Data Analysis.

Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin's lymphoma with increasing prevalence. Although the disease burden associated with DLBCL is high, only limited data on healthcare resource utilization (HCRU) and associated costs of German patients with DLBCL is available. Using a large claims database of the German statutory health insurance with 6.7 million enrollees, we identified patients who were newly diagnosed with DLBCL between 2011 and 2018 (index date). Treatment lines were identified based on a predefined set of medication. HCRU and related costs were collected for the entire post index period and per treatment line. A total of 2495 incident DLBCL patients were eligible for the analysis. The average follow-up time after index was 41.7months. During follow-up, 1991 patients started a first-line treatment, 868 a second-line treatment, and 354 a third-line treatment. Overall, patients spent on average (SD) 5.24 (6.17) days per month in hospital after index. While on anti-cancer treatment, this number increased to nine (10.9) in first-line, 8.7 (13.7) in second-line, and 9.4 (15.8) in third-line treatments. Overall costs per patient per month (PPPM) increased from €421 (875.70) before to €3695 (4652) after index. While on a treatment line, PPPM costs were €17,170 (10,246) in first-line, €13,362 (12,685) in second-line, and €12,112 (16,173) in third-line treatments. Time-unadjusted absolute costs sum up to €59,868 (43,331), €35,870 (37,387), and €28,832 (40,540) during first-line, second-line, and third-line treatments, respectively. The main cost drivers were hospitalizations (71% of total costs) and drug acquisition costs (18% of total costs). The financial burden of DLBCL in Germany is high, mainly due to hospitalization and drug costs. Therefore, there is a high medical need for new cost-effective therapeutic options that can lower the disease burden and remain financially viable to support the growing number of patients with this aggressive disease.

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

Cost to Treat Newly Diagnosed Patients with Paroxysmal Nocturnal Hemoglobinuria: A Retrospective Analysis

Background Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hematologic disorder that renders affected patients’ red blood cells susceptible to premature destruction (i.e., hemolysis) and can lead to excess morbidity. Current pharmacological treatments for PNH include not only eculizumab, launched in 2007, but more recently approved treatments such as ravulizumab and pegcetacoplan. Even among patients treated with currently available therapies, suboptimal C5 inhibition or exacerbating factors such as infections may result in breakthrough hemolysis or other PNH-related complications. Given the evolving treatment landscape and challenges in treatment and diagnosis, it is unclear what the total and setting-specific costs and health care utilization are among patients newly diagnosed with PNH. Objectives To determine healthcare resource utilization and costs for newly diagnosed patients with PNH. Methods United States (US) adults with a new ICD-10 diagnosis of PNH (D59.5) from April 2016 to December 2020 identified in the OptumLabs claims data were included. The date of the first claim with a PNH diagnosis was defined as the index diagnosis date. Patients were required to have at least 6 months of continuous enrollment before the index diagnosis date to identify newly diagnosed patients and at least 6 months of continuous enrollment after the index diagnosis date for analysis. Comorbidity was measured with the National Cancer Institute (NCI) comorbidity index. All-cause healthcare resource utilization (HCRU), all-cause costs, PNH-related HCRU (defined as claims with an ICD-10 code of D59.5 in any position), and PNH-related costs were measured on a per-patient per-month (PPPM) basis for inpatient admissions, emergency department (ED) visits, office visits, and other outpatient visits for the 6-month follow-up period. The PPPM frequency of blood transfusions and utilization of bone marrow transplant were also assessed. The cost and HCRU results were age-weighted to be representative of the US population. Results Of the 749 patients with an ICD-10 diagnosis of PNH (D59.5) during the selected timeframe, 381 were newly diagnosed patients who met all inclusion criteria. In the unweighted sample, approximately half of the patients (50.9%) were female, with an average age of 61.3 (SD = 17.8), and the average NCI Comorbidity Index was 0.57 (SD = 0.65). Of the 381 patients in the weighted sample, 149 (39.1%) had an inpatient admission. Of these inpatient admissions, 86 (57.7%) were PNH-related. For patients with at least one inpatient admission, the mean length of stay (LOS) was 2.2 days (SD = 3.0) and the median LOS was 1.0 days. One hundred twenty-three (32.3%) PNH patients had an emergency department (ED) visit in the first 6 months after the index diagnosis, 12 of which (9.8%) were PNH-related. Nearly all patients had office visits (97.9%) or other outpatient visits (96.6%) in the 6-month follow up period. Blood transfusions occurred in 18.6% of the PNH population, while bone marrow transplant was relatively rare (result suppressed due to small cell size). (Table 1) The PPPM total cost for newly diagnosed patients was $10,480, or $125,758 per patient per year. Of these costs, 39.0% ($4,090 PPPM) were for pharmacy costs (including infusion costs), 33.9% ($3,551 PPPM) were for inpatient costs, 6.4% ($672 PPPM) were for office visits, 0.9% ($94 PPPM) were for ED visits, and 19.8% ($2,073 PPPM) were for other outpatient visits. The total PNH-related cost was $4,763 PPPM, accounting for 45% of the total cost. PNH-related pharmacy costs for eculizumab and ravulizumab, including administration, accounted for 60.2% ($2,868) of PNH-related costs (no pegcetacoplan use was observed since it was approved in 2021). PNH-related inpatient costs accounted for 28.0% ($1,333), office visits accounted for 3.6% ($172), and other outpatient visits accounted for 8.1% ($386) of total PNH-related costs. ED visits were rarely flagged with the PNH ICD-10 code, with less than 0.1% of PNH-related costs coming from the ED. (Figure 1) Conclusions Despite new treatment options available for PNH, HCRU and associated costs remain high with 39.1% of PNH patients having an inpatient visit in the first 6 months after diagnosis. Nearly one in five newly diagnosed PNH patients still require at least one blood transfusion in the follow-up period, signaling further unmet medical need in PNH. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Total Cost of Care in Relapsed/Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL)

Background: DLBCL is the most common type of non-Hodgkin lymphoma, and 30-40% of patients develop R/R DLBCL (Sehn LH and Salles G. N Engl J Med 2021), which is associated with substantial treatment cost. Previous studies evaluated the total healthcare costs by line of therapy (LoT) (Danese MD, et al. Leuk Lymphoma 2017; Tkacz J, et al. Leuk Lymphoma 2020; Yang X, et al. Oncologist 2021; Mutebi A, et al. ISPOR 2022); however, these studies have not been updated with more recent real-world data. This analysis evaluated the total cost of care and health resource utilization associated with R/R DLBCL therapies by LoT, including those recently approved, to understand the impact of novel therapies such as chimeric antigen receptor T-cell (CAR-T) therapy on total cost of care and resource use in the R/R DLBCL setting. Methods: We evaluated healthcare costs and resources for each regimen in the second-line (2L) setting and beyond in patients who received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like therapy (at least rituximab, cyclophosphamide, and one corticosteroid) as first-line (1L) treatment for DLBCL between January 1, 2015 and June 30, 2021 using the IQVIA PharMetrics® Plus Database (Figure A). Costs were assessed for each LoT from the first administration date until the beginning of a new regimen (defined by receipt of a new regimen given after a treatment gap of 60 days, or the addition/substitution of new agents ≥30 days after starting initial therapy [adapted from Yang X, et al. Oncologist 2021]), a treatment gap of 180 days, or end of follow-up. Systemic therapies initiated <30 days before the start of CAR-T therapy or stem cell transplant (SCT) were considered pre-treatment and were included in the costs for only that LoT, to be inclusive of conditioning and bridging treatments. Total cost of care (TCC) was defined as all-cause healthcare costs. Healthcare resource utilization (HCRU) costs and events were defined using inpatient, outpatient, pharmacy, and emergency room (ER) categories. Baseline characteristics, including age and payer type at index, sex, and US region were assessed in the 12 months pre-index. TCC was reported as per patient per month (PPPM) and per patient per LoT. Data were descriptively assessed. Results: The final analysis cohort included 236 patients with a median age at first ≥2L treatment of 60 years (interquartile range [IQR] 54-64), 37% of patients were female, and median follow-up from 1L initiation was 21 months [IQR 13-35]. Of the patients who received 2L treatment, 44.5% (105/236) received third-line (3L) treatment and 16.9% (40/236) received fourth-line (4L) treatment. CAR-T therapy use increased in later LoTs (5.9% in 2L, 5.7% in 3L, and 17.5% in 4L). SCT was frequently used across all LoTs (25.8% in 2L, 50.5% in 3L, and 32.5% in 4L). The mean TCC PPPM by LoT was $41,700 (standard deviation [SD] $39,767) for 2L, $58,906 (SD $70,966) for 3L, and $81,927 (SD $79,152) for 4L. Mean PPPM HCRU costs generally increased by LoT for inpatient and pharmacy claims, and costs were highest in 4L for all HCRU categories (Figure B). PPPM HCRU events were highest in the 4L setting for outpatient visits only (Figure B). Conclusion: This economic analysis demonstrated that total healthcare costs in R/R DLBCL increase with each additional LoT. Cost estimates by LoT appeared higher than previously reported (Tkacz J, et al. Leuk Lymphoma 2020; Mutebi A, et al. ISPOR 2022), and may be a result of the increase in SCT and CAR-T therapy use. Inpatient costs represented the highest percentage of total costs, followed by outpatient costs. New 1L treatments that are both efficacious and cost-effective in DLBCL are needed to reduce the economic burden to the healthcare system in the R/R DLBCL setting. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Healthcare Resource Utilization and Associated Costs of German Patients with Diffuse Large B-Cell Lymphoma (DLBCL) - a Retrospective Health Claims Data Analysis

Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphoma with increasing prevalence. Although the disease burden associated with DLBCL is high, only limited data on healthcare resource utilization (HCRU) and associated costs of German patients with DLBCL is available. Using a large claims database of the German statutory health insurance with 6.7 million enrollees, we identified patients who were newly diagnosed with DLBCL (index date) and had no other cancer co-morbidity. Identification period was between 2011 and 2018 and post index period had to be at least one year except for death. Treatment lines were identified based on a predefined set of medications categorized by established DLBCL treatment recommendations. HCRU and related costs were collected for the entire post index period and per treatment line. 2,495 incident DLBCL patients were eligible for the study. The average follow up time after index was 41.7 months. During follow up 1,991 patients started a 1st line treatment, 868 a 2nd line treatment, and 354 a 3rd line treatment. Overall, patients spent on average 5.24 days per month in hospital after index. While on anti-cancer treatment this number increase to 9 in 1st line, 8.7 in 2nd line, and 9.4 in 3rd line treatment. Overall costs per patient per month (PPPM) were €3,695 after index. While on a treatment line, PPPM costs were €17,170 in 1st line, €13,362 in 2nd line, and €12,112 in 3rd line. Absolute costs sum up to is €59,868, €35,870, and €28,832 during 1st line, 2nd line, and 3rd line, respectively. Main cost drivers were hospitalizations (71% of total costs) and drug acquisition costs (18% of total costs). The financial burden of DLBCL in Germany is high and there is a high medical need for new cost effective therapeutic options that can lower the disease burden and remain financially viable to support the growing number of patients with this aggressive disease.

Abstract 15002: Real-World Healthcare Resource Utilization Among US Patients With Atrial Fibrillation Receiving Dronedarone versus Ablation as 1st-Line Therapy

Introduction: Catheter ablation is used increasingly as a 1st-line (1L) alternative to antiarrhythmic drugs (AAD) including dronedarone in patients with atrial fibrillation (AF). Healthcare resource utilization (HCRU)-related costs with dronedarone vs 1L ablation are unknown. Methods: We conducted a retrospective, observational cohort study using Optum Clinformatics Data Mart® from Jan 2012-Jan 2022 among US adults with AF and no prior rhythm control therapy who received new AAD therapy with dronedarone (index: date of incident dronedarone fill) vs those who received 1L ablation, or a non-dronedarone AAD followed by ablation within 3 mo (index: date of first recorded ablation or AAD). Patients were required to have ≥24 mo of pre-index data, and ≥3 mo follow-up. Patients in the 1L ablation cohort were propensity score matched 2:1 to the dronedarone cohort. Mean payer costs per patient per month (PPPM) during the 24-mo post-index period were calculated for total HCRU, inpatient visits, emergency room (ER) visits, outpatient physicians’ office visits, and all outpatient visits, and compared by zero-inflated negative binomial (ZINB) regression model. Results: Post-matching, the dronedarone (n=1440) and 1L ablation (n=2253) cohorts had similar baseline characteristics (mean age at index: 68.4 vs 67.7 years; male: 57.7% vs 59.3%; mean time from AF diagnosis to index: 80.2 vs 91.6 days; Charlson comorbidity index: 2.3 vs 2.2; CHADS2-VASc score: 3.4 vs 3.2). Mean PPPM costs were lower with dronedarone vs 1L ablation for all-cause total HCRU, inpatient visits, any outpatient visit, ER visit, and outpatient office visit (Table). ZINB analyses showed significant cost differences for all-cause total HCRU and any outpatient visit events. Conclusion: In patients with AF and no prior rhythm control therapy, 1L dronedarone was associated with lower total HCRU and outpatient visit costs during 24-mo follow-up vs 1L ablation; future studies will assess cost-effectiveness.

Health care resource utilization and costs among individuals with vs without Huntington disease in a US population.

BACKGROUND: Quantifying the extent of health care resource utilization (HCRU) and costs associated with Huntington disease (HD) is vital for providers, decisionmakers, and payers to understand unmet treatment needs and to ensure limited resources can be used to benefit the maximum number of people with HD. OBJECTIVE: To quantify HCRU and costs for people with HD, overall and by disease stage, and compare these with non-HD controls. METHODS: This was a retrospective cohort study using administrative claims data from the IBM MarketScan Commercial, Multi-State Medicaid, and Medicare Supplemental Databases from January 1, 2009, to December 31, 2018. People with an HD claim between January 1, 2010, and December 31, 2017, were selected for this analysis and matched with non-HD controls for comparison. The HD cohort and the non-HD controls were exact matched on their follow-up duration and propensity score matched 1:4 to create the final analytical cohort. Index date was the first HD diagnosis for the HD cohort (proxy index date assigned to controls), and all individuals were required to have continuous enrollment for 12 or more months pre-index (baseline) and 3 or more months post-index. Proportions of all-cause HCRU (ie, outpatient visits, inpatient visits, emergency department visits, pharmacy fills, radiology visits, and physical/occupational therapy visits) in the 6-months post-index and HCRU counts and costs per patient per month (PPPM) over the entire follow-up were calculated for each cohort. RESULTS: A total of 2,473 individuals with HD and 9,522 matched non-HD controls were identified. HCRU in 6 months post-index was significantly greater in people with HD compared with non-HD controls for all health care service categories; P < 0.0001. The mean number of HCRU PPPM for all measured healthcare services was significantly higher in people with HD compared with non-HD controls (P < 0.001). Mean total costs (2018 USD PPPM) for the HD cohort ($2,260 [SD = $4,682]) were twice the total costs in the non-HD cohort ($1,056 [SD = $3,078]) (P < 0.0001) and were highest across all disease stages. CONCLUSIONS: This study provides current comprehensive HCRU and cost estimates in individuals with HD relative to those without the disease, thus demonstrating the high economic burden imposed by HD. DISCLOSURES: Dr Ta: Employment with Genentech (at time of study) and stock options with Roche; Dr To: Employment and stock options/dividends with Genentech; Dr Patel: Employment and stock options with Roche/Genentech; Dr Fuller: Employment with CHDI Management/CHDI Foundation; Mr Surinach: Employment with Genesis Research (which receives consulting fees from Genentech/Roche); Dr Abbass: Employment and stock options with Genentech; Dr Exuzides: Employment and stock options with Roche/Genentech; and Ms Luo: Employment with CHDI Management/CHDI Foundation. This study was funded by Genentech Inc. The authors thank Greg Rowe of Chrysalis Medical Communications for providing medical writing support, which was funded by F. Hoffmann-La Roche Ltd, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Clinical and economic burden of first-line chemoimmunotherapy by risk status in chronic lymphocytic leukemia

Objectives To evaluate the trend in cytogenetic/molecular testing rate in chronic lymphocytic leukemia (CLL) and assess the clinical and economic burden of first-line (1 L) treatment with chemoimmunotherapy (CIT) by risk status. Methods This retrospective cohort study identified patients with CLL from a U.S. managed care population. Medical records were obtained for eligible patients who initiated 1 L CIT between 1/1/2007 and 7/31/2019 and underwent prognostic testing to classify them as high risk (del(17p), TP53 mutation, del(11q), unmutated IGHV or complex karyotype) or as non-high risk by FISH only (non-del(17p) and non-del(11q)). Study outcomes included testing rate, time to next treatment (TTNT) or death, time to treatment failure (defined as time to change of therapy, non-chemotherapy intervention, hospice care or death), and total plan paid costs (medical + pharmacy) per patient per month (PPPM) in the 1 L period. Cox proportional hazard models and generalized linear models were used to calculate adjusted hazard ratio or rate ratio. Results Among the 1,808 patients with CLL, 612 were FISH or IGHV tested and the rate of testing increased from 30% to 44% from 2007–2019. High-risk patients (n = 119) had 65% higher risk of next treatment or death (median time: 2.4 vs 3.7 years), 65% higher risk of treatment failure (median time: 3.0 vs 4.9 years), and 33% higher costs ($12,194 vs $9,055, p = 0.027) during 1 L treatment than non-high risk patients (n = 134). Conclusions High-risk CLL patients treated with 1 L chemoimmunotherapy have poorer clinical and economic outcomes compared to non-high risk patients. Assessment of genetic risk remains suboptimal.

Estimating prevalence and financial impact of “bagging” oncology drugs: Evidence from privately-insured patients with cancer.

25 Background: “Bagging” is a drug delivery model that distributes physician-administered drugs through pharmacies, most specialty pharmacies. Under the traditional buy-in-bill model oncology drugs are covered in medical benefit, whereas drugs distributed through bagging practices are reimbursed under pharmacy benefit. Several professional associations have urged policymakers to limit or prohibit bagging practices, citing patient safety as the main concern. This study estimated the prevalence of bagging practice and the associated financial impact among cancer patients with private insurance. Methods: We selected 10 cancer drugs with highest total spending from the 2020 Medicare Part B Drug Spending Dashboard. Using 2019-2020 MarketScan data, we identified these drugs from medical and/or pharmacy claims and estimated the prevalence of “bagging” practice as the proportion of patients who had their cancer drugs covered by pharmacy benefit. We compared the per patient per month (PPPM) insurance payment and out-of-pocket expense (OOPE) between medical and pharmacy claims and tested the difference in PPPM costs using non-parametric Wilcoxon test. Results: The top 10 drugs selected for this study included four immunotherapy (pembrolizumab, nivolumab, durvalumab, atezolizumab), five targeted therapy drugs (rituximab, bevacizumab, daratumumab, trastuzumab, pemetrexed), and one supportive care product (pegfilgrastim). The study cohort consisted of 39,757 cancer patients, including 10,599, 19,276, and 17,882 patients (not mutually exclusive) receiving immunotherapy, targeted therapy agents, and supportive care drug, respectively. On average, “bagging” practice was observed in 4.4% of patients, ranging from less than 1% for immunotherapy and 2.4% for targeted therapy to 6.9% for supportive care drugs. The prevalence of bagging practice was higher in comprehensive plans (11.3%) and PPO (4.3%) versus other insurance plan types (3.8%). By census region, the prevalence was highest in Northeast (7.2%) and lowest in North Central (3.4%). Insurance payment PPPM was lower for drugs distributed through bagging practices than the conventional buy-and-bill model (mean $11,075 vs. $13,622; median $9,275 vs. $10,728, P &lt; 0.001). OOPE PPPM exhibited the opposite pattern, with mean and median OPPE $437 and $53 for bagging practices and $186 and $0 for buy-and-bill. Conclusions: We observed wide variation in bagging practices by drug classes, plan types, and geographic regions. Evidence from the privately insured suggested that although bagging oncology drugs appeared to have reduce oncology drug costs for payors, this practice was associated with higher OOP for cancer patients with private insurance. Future research should examine the impact of bagging practices on clinical outcomes, such as treatment delays or disruptions and treatment-related side effects.

AML-430 A Surveillance, Epidemiology, and End Results (SEER)-Medicare Analysis of the Economic Burden Among Elderly Patients With Acute Myeloid Leukemia (AML) Treated With Hypomethylating Agents (HMA)

The economic burden of relapse among Medicare patients with newly diagnosed AML is high, with >50% receiving ≥1 cycle of HMA therapy. To assess healthcare resource utilization (HCRU) and costs associated with AML phases among elderly patients who received HMA monotherapy only during induction, followed by remission. A retrospective analysis of Medicare claims (parts A, B, and D; 2007-2016) and cancer diagnoses (2007-2015) in the SEER-Medicare database was conducted. Eligible patients were diagnosed with AML at ≥65 years of age and had initiated HMA in the outpatient (OP) setting during the first post-diagnosis induction cycle, followed by remission. Induction period was from HMA initiation (index date) to the end of cycle when remission occurred. The baseline period was the 6 months preceding index date. The post-relapse phase was from date of first AML post-remission relapse to end of follow-up. HCRU and costs (adjusted to 2019 USD) associated with induction and post-remission therapy were assessed during the treatment cycle. Of 71 eligible patients, 50.7% were male and 85.9% were White, with AML diagnosis at a median age of 78.8 years. Mean number of total treatment days was 181.3 and 153.0 for induction and post-remission phases, respectively. Among all patients, 43.7% had relapsed and 85.9% had died by the end of follow-up. During induction, post-remission, and post-relapse phases, 91.5%, 77.8%, and 77.4% of patients received a blood transfusion, respectively. The proportion of patients with inpatient (IP) visits was highest in the post-relapse phase, with 77.4% having ≥1 visit. Mean perpatient monthly (PPM) healthcare costs were highest for the post-relapse phase, followed by the post-remission and induction phases. OP-setting costs were the greatest contributor to induction costs (48.6%), while IP-setting costs contributed most to post-remission (56.2%) and post-relapse (72.8%) phase costs. The economic burden of AML treated with HMA was highest in the post-relapse phase, approximately 1.7x and 1.6x the PPM costs during induction and post-remission phases, respectively. In addition, IP costs made up approximately two-thirds of total PPM costs in the post-relapse phase, up from approximately 44% and 56% of the induction and post-remission phases, respectively.

Healthcare Costs Among Patients with Psoriasis Treated with Ixekizumab Versus Secukinumab in Real-World Settings Over 24 Months.

ObjectiveThe aim of this study was to compare healthcare costs between ixekizumab (IXE)-treated and secukinumab (SEC)-treated patients with psoriasis over a 24-month follow-up period in the United States.MethodsPatients with psoriasis diagnosis were identified from IBM Watson Health MarketScan® Research Databases; those with one or more claim for index drug (IXE or SEC) between March 1, 2016 and October 31, 2019 were included. Included patients were ≥ 18 years old and had continuous enrollment with medical and pharmacy benefits ≥ 6 months before and ≥ 24 months after index date. Patients were classified as IXE or SEC users based on drug received at index. Per patient per month (PPPM) all-cause, psoriasis-related, and index drug costs for IXE and SEC users were estimated over 24 months of follow-up. Institute for Clinical and Economic Review (ICER) discount factors were applied to adjust pharmacy costs. Index drug costs were additionally adjusted for adherence. Inverse probability of treatment weighting was used to address cohort imbalances. Chi-square/t tests were used to compare IXE versus SEC users; p value < 0.05 was considered statistically significant.ResultsOverall, 1461 patients (IXE users, n = 471; SEC users, n = 990) were included. IXE versus SEC users had higher weighted PPPM all-cause, psoriasis-related, and index drug costs (p ≤ 0.001). IXE versus SEC users had comparable ICER-adjusted mean PPPM all-cause costs (US$4172 ± 3349 vs US$3978 ± 2619; p = 0.227) and psoriasis-related costs (US$2950 ± 1332 vs US$2899 ± 1152; p = 0.447). After applying ICER and adherence adjustments, index drug costs were similar between IXE and SEC users (US$3794 ± 1822 vs US$3766 ± 1973; p = 0.795).ConclusionsAll-cause and psoriasis-related costs were comparable between IXE and SEC users after ICER adjustments; index drug costs were similar after ICER and adherence adjustments.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-022-00365-z.

Clinical manifestation, economic burden, and mortality in patients with transthyretin cardiac amyloidosis

BackgroundTransthyretin cardiac amyloidosis, also known as transthyretin cardiomyopathy (ATTR-CM) is a poorly-recognized disease with delayed diagnosis and poor prognosis. This nationwide population-based study aimed to identify disease manifestations, economic burden, and mortality of patients with ATTR-CM.MethodsData of newly diagnosed patients with ATTR-CM between 2013 and 2018 from the Korean National Health Insurance Service were used, covering the entire population. Patient characteristics included comorbidities, medical procedures, and medication. Healthcare resource utilization and medical costs were observed as measures of the economic burden. The Kaplan–Meier survival curve and years of potential life lost (YPLL) from the general population were estimated for disease burden with ATTR CM.ResultsA total of 175 newly diagnosed patients with ATTR-CM were identified. The most common cardiac manifestation was hypertension (51.3%), while the most common non-cardiac manifestation was musculoskeletal disease (68.0%). Mean medical costs at the post-cohort entry date were significantly higher than those at the pre-cohort entry date ($1,864 vs. $400 per patient per month (PPPM), p < 0.001). Of the total medical costs during the study period, the proportion of inpatients cost was 12.9 times higher than the outpatients cost ($1,730 and $134 PPPM, respectively). The median survival time was 3.53 years from the first diagnosis of ATTR-CM, and the mean (SD) YPLL was 13.0 (7.7).ConclusionsPatients with ATTR-CM had short survival and high medical costs. To reduce the clinical and economic burdens, carefully examining manifestations of disease in patients can help with early diagnosis and treatment.

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.

Healthcare resource utilization and costs in individuals with Huntington’s disease by disease stage in a US population

Aims To quantify healthcare resource utilization (HRU) and costs by disease stage in individuals with Huntington’s disease (HD) in a US population. Materials and methods This retrospective cohort study used administrative claims data from the IBM MarketScan Commercial, Multi-State Medicaid, and Medicare Supplemental Databases between 1 January 2009 and 31 December 2018. Individuals with an HD claim between 1 January 2010 and 31 December 2017 were selected. Index date was the date of first HD diagnosis. Individuals were required to have continuous enrollment for ≥ 12 months pre-index, 3 months post-index, and have no pre-index HD claims. All-cause HRU and costs per patient per month (PPPM) (overall and stratified by disease stage) were assessed for individuals with HD. Results A total of 2,669 individuals with HD were identified. Of these, 1,432 (53.7%), 689 (25.8%), and 548 (20.5%) had early-, middle-, and late-stage HD at baseline, respectively. Mean HRU PPPM by post-index HD stage increased with disease stage for outpatient visits, pharmacy claims, and HD-related pharmacy claims (p < 0.05 for all). Mean inpatient visits and emergency room visits PPPM were highest in individuals with middle-stage HD (p <0.05 for all). Mean total all-cause healthcare cost PPPM for individuals with HD was $2,889, and it was significantly higher in middle-stage individuals, at $7,988, compared with early- and late-stage individuals, at $3,726 and $5,125, respectively; p <0.0001. Limitations In the absence of disease staging information in administrative claims data, staging was based on the presence of clinical markers in claims. Our evaluations didn’t include the indirect costs of HD, which may be substantial as HD typically affects people at their peak earning potential. Conclusions HRU and costs of care are high among individuals with HD, particularly among those with middle- and late-stage disease. This indicates that the disease burden in HD increases with disease stage, highlighting the need for interventions that can slow or prevent disease progression.