Real-world Healthcare Resource Use Research Articles

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.

A retrospective observational study on characteristics, treatment patterns, and healthcare resource use of patients with myasthenia gravis in England.

There are limited data on the real-world healthcare resource use (HCRU) and management costs of myasthenia gravis (MG) in England. This study aims to assess the burden of disease for patients with MG in England. A retrospective, observational cohort study of adult patients diagnosed with MG, using data from the Hospital Episode Statistics data warehouse. Patients with a first-ever recorded diagnosis of MG between 30 June 2015 and 30 June 2020 were followed up until 30 June 2021 or death, whichever occurred first. Post-diagnosis patient characteristics, treatment patterns, HCRU, and costs were described. Costs were evaluated using National Health Service reference costs. A total of 9087 patients with a median follow-up time of 2.9 years (range, 1.7-4.3 years) were included. The mean age at diagnosis was 66.5 years and 53% of the patients were male. A large proportion of patients (72.8%) were admitted as inpatients during follow-up with a mean number of 1.3 admissions. Patients hospitalized for MG-related complications spent a mean of 9.7 days per patient-year in the hospital. During follow-up, 599 (6.6% of the total cohort) and 163 (1.8%) patients had a record of rescue therapy with intravenous immunoglobulin (IVIg) and plasma exchange (PLEX), respectively. Rituximab was administered to 81 (0.9%) patients and 268 (2.9%) patients underwent thymectomy. In those patients receiving rescue therapy or rituximab, >10% received at least three cycles of the same treatment. The average annual cost of hospital admissions across all patients treated with IVIg, PLEX, and rituximab were £907,072, £689,979, and £146,726, respectively. A majority of MG patients required hospitalization or accident and emergency attendance, resulting in high HCRU and costs. A subset of patients required rescue therapy (including IVIg and PLEX), rituximab administration, ventilation, or thymectomy.

RWD128 A Retrospective Claims Analysis Characterizing Health Care Resource Use Among Patients with Friedreich Ataxia in the United States

Friedreich Ataxia (FA) is a progressive and systemic neuromuscular disease, affecting ∼1:20,000 births, characterized by ataxia, scoliosis, and loss of ambulation, and other clinical manifestations. Our aim was to characterize real-world healthcare resource use (HCRU) among commercially insured patients with FA in the United States (US) and compare that to non-FA patients.

EE145 Real-World Healthcare Resource Use, Costs, and Treatment Patterns in Advanced or Metastatic Non-Small Cell Lung Cancer Patients with Different Epidermal Growth Factor Receptor Mutation Types

This study described healthcare resource utilization (HRU), costs, and treatment patterns among advanced or metastatic non-small cell lung cancer (a/mNSCLC) patients with different EGFRmutation types.

Healthcare Resource Use And Costs Among A Large, Diverse Sample Of Asthma Patients In The United States

The economic impact of asthma is substantial; however, burden estimates are outdated. We examined real-world healthcare resource use (HCRU) and costs among a large, diverse sample of patients with asthma in the United States.

A systematic review of real-world healthcare resource use and costs of Clostridioides difficile infections.

To conduct a systematic review of published real-world evidence describing the cost and healthcare resource use for Clostridiodes difficile infection (CDI) in the United States. A systematic literature review was conducted searching for terms for CDI and healthcare costs. Titles of articles and abstracts were reviewed to identify those that met study criteria. Studies were evaluated to examine overall design and comparison groups in terms of healthcare resource use and cost for CDI. In total, 28 articles met the inclusion criteria. Moreover, 20 studies evaluated primary CDI or did not specify, and 8 studies1-8 evaluated both primary CDI and recurrent (rCDI). Data from Medicare were used in 6 studies. Nearly all studies used a comparison group, either controls without CDI (N = 20) or comparison between primary CDI and rCDI (N = 7). Two studies examined costs of rCDI by the number of recurrences. Overall, the burden of CDI is significant, with higher aggregate costs for patients with rCDI. Compared with non-CDI controls, hospital length of stay increased in patients with both primary and rCDI compared to patients without CDI. Patients with primary CDI cost healthcare systems $24,000 more than patients without CDI. Additionally, 2 studies that evaluated the impact of recurrence among those patients with an index case of CDI demonstrated significantly higher direct all-cause medical costs among those with rCDI compared to those without. CDI, and particularly rCDI, is a costly condition with hospitalizations being the main cost driver.

Healthcare resource use in myasthenia gravis: a US health claims analysis.

There are limited data on the impact of myasthenia gravis (MG) on real-world healthcare resource use (HCRU) and patient burden in the United States. This study aims to assess HCRU in patients with MG using data from a US health claims database. A retrospective, database study of adult patients newly diagnosed with MG, using the IBM® MarketScan® Commercial Claims and Encounters and Medicare supplemental health insurance claims database. Patients with ⩾2 MG International Classification of Disease diagnosis codes ⩾3 months apart were followed from the date of their first MG diagnosis record or start of treatment. HCRU and use of immunoglobulins and plasma exchange during follow-up was assessed, as well as comorbidities, hospitalizations, emergency room (ER) visits, intensive care unit (ICU) admissions, and specialist visits per year after diagnosis, and compared with age- and sex-matched non-MG controls. During 2010-2019, 7194 patients were followed for up to 10 years (median = 2.3 years). During follow-up, patients with MG were 2.6-fold more likely than controls to be hospitalized, and 4.5-fold more likely to be admitted to an ICU. Risk and numbers of ER admission, hospitalization, and ICU visits were the highest in the 12 months post-diagnosis of MG and were consistently higher than controls during follow-up. MG was the main cause for most hospitalizations. Patients with MG have higher HCRU, compared with the age- and sex-matched non-MG controls. The early years after MG diagnosis are a period of particularly high healthcare burden, with many patients requiring hospitalization and ICU care to manage serious exacerbations.

EE612 Healthcare Resource Utilization and Costs Among Patients With Chronic Obstructive Pulmonary Disease in the United States

Globally, chronic obstructive pulmonary disease (COPD) is associated with substantial economic burden to healthcare systems. This study examined real-world healthcare resource use (HCRU), costs and HCRU predictors in patients with COPD in the United States.

Real-world healthcare resource utilization and costs among patients with multiple myeloma in the United States.

e18811 Background: The economic burden of multiple myeloma (MM) has been shown to increase with more advanced lines of therapy (LOTs). Given the rapidly evolving treatment landscape of MM, this study aimed to describe the current real-world healthcare resource use (HRU) and costs among patients with MM across LOTs. Methods: A commercial insurance claims database was used to identify patients with ≥2 MM diagnoses who initiated a LOT containing an antineoplastic agent for MM between 1/2016 and 2/2021, had continuous insurance coverage ≥6 months before and ≥60 days after first line (1L) initiation, and never received stem cell transplant. LOTs were defined based on agents used within a 60-day period. End of LOT was defined when patients switched treatment, or after a treatment gap of 90 days. HRU and costs (in 2021 USD) were reported for the duration of each LOT (from initiation of LOT to initiation of a subsequent LOT or end of coverage). Results: 1492 patients initiated 1L, 681 initiated 2L, 359 initiated 3L and 188 initiated 4L. Mean age at 1L initiation was 66.6 years. Mean duration of LOT (10.7, 9.4, 8.1 and 10.2 months in 1L, 2L, 3L and 4L, respectively) was longer in 1L than in subsequent LOTs. All-cause monthly outpatient (OP) and inpatient (IP) visits were stable across LOTs (5.0-5.6 OP visits; 0.21-0.32 IP visits). However, mean monthly all-cause costs were lowest in 1L (15.9% - 34.9% lower) as compared to subsequent LOTs ($23.6K in 1L, $29.7K in 2L, $27.3K in 3L and $31.8K in 4L; Table). Conclusions: In this study, the duration of LOT was the longest among 1L patients. Total all-cause healthcare costs were the lowest in 1L than in more advanced LOTs. This suggests that selection of 1L best treatment regimen upfront that prolongs time to disease progression could reduce the overall economic burden of MM.[Table: see text]

Healthcare Costs for Metastatic Castration-Resistant Prostate Cancer Patients Treated with Abiraterone or Enzalutamide

ObjectiveThe aim was to assess the real-world healthcare resource use and direct medical costs for metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone or enzalutamide, in whom chemotherapy is not yet indicated (pre-chemotherapy) or who had previously received docetaxel-based chemotherapy (post-chemotherapy), before commencing these medicines.MethodsA retrospective cost analysis of mCRPC patients who commenced abiraterone or enzalutamide between 2012 and 2015 was conducted. Routinely collected datasets from the largest health board in Scotland and the UK, Greater Glasgow and Clyde, were linked. They contained information on patient demographics, diagnosis, outpatient consultations, hospital admissions, treatments (abiraterone and enzalutamide), and supportive medicines. Unit costs were obtained from the Scottish Health Service Costs, Personal Social Services Research Unit, and British National Formulary. Generalised linear model-based regression was used to estimate total mean direct costs, and two-part models were used to estimate separate cost components. All models were adjusted for propensity score and key variables. Sensitivity analysis was conducted to explore the impact of hypothetical patient access scheme discounts.ResultsEstimated total mean direct medical costs of treating mCRPC patients were similar, albeit with wide and overlapping confidence intervals. Across both treatments, patients who received abiraterone or enzalutamide in a pre-chemotherapy setting incurred the highest total mean direct medical costs. However, post-chemotherapy patients were associated with higher outpatient clinic visits, inpatient hospital admissions, and supportive medicines. Regarding relative contribution to the total mean direct medical cost, the treatment costs were the main contributor, followed by inpatient admissions, outpatient clinic visits, and supportive medicines.ConclusionThe total mean direct medical costs were similar for abiraterone and enzalutamide patients. The costs were not driven by the choice of treatment regimen, but treatment setting (pre-chemotherapy or post-chemotherapy indications) and related healthcare resource utilisation. Future studies should focus on economic evaluations, such as cost-effectiveness analyses, using real-world data.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-021-00307-1.

First Salvage Therapy for Relapsed or Refractory Acute Myeloid Leukemia: Associated Health Care Resource Use and Costs

BackgroundFor relapsed/refractory acute myeloid leukemia (R/R AML), treatments used include high-intensity cytotoxic chemotherapy regimens (HIC); low-intensity chemotherapy (LIC); targeted therapies administered as either a single agent or as part of combination therapy; or venetoclax, often in combination with LIC. As options increase for patients with R/R AML, an understanding of the real-world health care resource use (HRU) and costs associated with different treatment regimens is needed.ObjectiveWe described HRU and costs associated with HIC alone, LIC alone, and select novel, orally administered therapies (alone or in combination with chemotherapy) to better understand HRU and costs of first salvage therapy for AML.MethodsThis was a retrospective analysis using the IBM MarketScan ® database which contains medical and drug data from ~40 million people annually who are covered by employer-sponsored private health insurance in the United States. The time frame for this claims analysis was 1/1/2017-12/31/2019. HRU and costs were estimated for 5 mutually exclusive treatment groups: HIC alone, LIC alone, gilteritinib, other FLT3 tyrosine kinase inhibitors (TKIs), and venetoclax. Gilteritinib, other FLT3 TKIs, and venetoclax treatments could be single-agent or in combination with chemotherapy. Patients aged ≥18 years at AML diagnosis with continuous health plan enrollment for ≥180 days prior to first AML diagnosis and through start of first salvage therapy were included in the analysis. Evidence of R/R AML was determined by diagnosis code and use of a treatment-based algorithm (Grinblatt DL, et al. Blood. 2020;136[Suppl. 1]:24-25). Descriptive statistics were used to characterize baseline patient demographic and clinical characteristics and HRU and costs through treatment. HRU and costs were reported as per-patient per-month (PPPM).ResultsMost baseline characteristics were similar across treatment groups (eg, % male, 45.6%-57.1%; mean Charlson comorbidity scores, 3.07-3.86; and mean all-cause health care costs during 6-months pretreatment, $201,583-$253,437). Mean (SD) patient age overall was 54.1 (14.9) years; the venetoclax group appeared older (61.2 years). The frequency of prior HIC treatment in the overall sample was 38.1%; a majority of patients treated with gilteritinib (64.3%) and other FLT-3 TKIs (55.9%) had prior HIC treatment. Of patients receiving gilteritinib, other FLT3 TKIs, and venetoclax, 6 (42.9%), 33 (48.5%), and 77 (96.3%) respectively, were receiving concomitant chemotherapy. Almost all patients were hospitalized during HIC; the percentage of patients requiring hospitalization was lower and comparable across other treatment groups (Table). Hospital length of stay was highest in the HIC group and lowest in the gilteritinib group. Intensive care unit stays PPPM were highest in the HIC and venetoclax groups and lowest in the gilteritinib group. In the outpatient setting, physician office visits and outpatient hospital visits PPPM were higher in the LIC, other FLT3 TKIs, and venetoclax groups and lower in the HIC and gilteritinib groups (Table). Transfusion-related physician office and outpatient hospital visits PPPM were higher in the venetoclax group than in the other groups. The highest health care costs PPPM were in the HIC group with costs being similar for the other treatment groups (Table). Inpatient costs were highest in the HIC group and lowest in the gilteritinib group; outpatient costs were highest in the LIC and venetoclax groups and lowest in the HIC, gilteritinib, and other FLT3 TKI groups. Transfusion costs in the outpatient setting were the highest in the venetoclax group and the lowest in the gilteritinib group. Prescription claim costs were the highest in the gilteritinib group and lower in the HIC, LIC, and venetoclax groups.ConclusionAcross select treatments for R/R AML in first salvage, inpatient HRU was generally the highest for the HIC group while outpatient HRU was generally the highest in the LIC and venetoclax groups, with the highest number of outpatient transfusion visits noted in the venetoclax group. Analyses of total all-cause costs showed that costs were the highest in the HIC group and similar in the LIC, gilteritinib, other FLT3 TKIs, and venetoclax groups. Although prescription drug costs were high in the gilteritinib group, these high costs were partially offset by low HRU in both the inpatient and outpatient settings. [Display omitted] DisclosuresMuffly: Adaptive: Honoraria, Other: fees for non-CME/CE services: , Research Funding; Astellas, Jasper, Adaptive, Baxalta: Research Funding; Pfizer, Amgen, Jazz, Medexus, Pfizer: Consultancy. Young: Astellas Pharma, Inc.: Current Employment. Nimke: Astellas Pharma, Inc.: Current Employment. Sullivan: Astellas Pharma, Inc.: Current Employment. Feng: Astellas Pharma, Inc.: Current Employment. Pandya: Astellas Pharma, Inc.: Current Employment.

Evaluation of Real-World Healthcare Resource Utilization and Associated Costs in Children with Juvenile Idiopathic Arthritis: A Canadian Retrospective Cohort Study.

IntroductionJuvenile idiopathic arthritis (JIA) is a chronic rheumatic disease, whose multifaceted care path can lead to significant expenditure for the healthcare system. We aim to assess the real-world healthcare resource use (HCRU) and associated cost for children with JIA in a single center in Canada.MethodsA single-center consecutive cohort of newly diagnosed patients with JIA attending the pediatric rheumatology clinic from 2011 to 2019 was identified using an administrative data algorithm and electronic medical charts. HCRU was estimated from six administrative health databases that included hospital admissions, emergency, outpatient care, practitioners’ visits, medication, and laboratory and imaging tests. Costs were assigned using appropriate sources. We reported the yearly overall and JIA-associated HCRU and costs 5 years prior to and 6 years after the first visit to the pediatric rheumatologist. The Zhao and Tian estimator was used to calculate cumulative mean costs over a 6-year timeframe. Results were stratified by disease subtype.ResultsA total of 389 patients were identified. The yearly total overall mean costs per patient ranged between $804 and $4460 during the 5 years prior to the first visit to the pediatric rheumatologist and $8529 and $10,651 for the 6 years after. Medication cost, driven by use of biologic therapies, and outpatient visits were the greatest contributor to the total cost. The overall cumulative mean cost for 6 years of care was $48,649 per patient, while the JIA-associated cumulative mean cost was $26,820 per patient. During the first year of rheumatology care, systemic onset JIA had the highest cumulative mean overall cost, while oligoarticular JIA had the lowest cumulative mean cost.ConclusionThe care pathway for children with JIA can be expensive, and complex—and varies by JIA subtype. Although the yearly total mean cost per patient was constant, the distribution of costs changes over time with the introduction of biologic therapies later in the care pathway. This study provides a better understanding of the JIA costs profile and can help inform future economic studies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-021-00331-x.

Healthcare resource use (HRU) by infusion setting of chimeric antigen receptor T-cell (CAR-T) in patients with relapsed and refractory (r/r) diffuse large B-cell lymphoma (DLBCL): A retrospective cohort study using CMS 100% Medicare database.

e19550 Background: Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are CAR-T therapies that were approved for r/r DLBCL in 2017 and 2018, respectively. While majority of the CAR-T infusions occur at inpatient (IP) setting in clinical trials, CAR-T infusions can also occur in the outpatient (OP) setting. This study aimed to compare the real-world HRU between IP vs. OP infusion of CAR-T among patients with r/r DLBCL. Methods: Adult patients with r/r DLBCL receiving tisa-cel or axi-cel were selected from the CMS 100% Medicare data from 2017 to 2019 and classified into IP and OP cohorts based on CAR-T infusion setting. Number of IP, OP, intensive care unit (ICU) visits, IP days, and ICU days by month post-CAR-T infusion were compared between cohorts using generalized linear models, adjusting for age, sex, race, and National Cancer Institute comorbidity index. Average length of stay (LOS) per IP episode during the first month was also described. Results: A total of 430 patients receiving CAR-T (380 IP and 50 OP) were identified. Among those with CAR-T regimen identifiable in the OP cohort, 90.2% received tisa-cel and 9.8% received axi-cel. Mean age at CAR-T infusion in IP and OP cohorts was 70.8 and 68.4 years, respectively. Most of the CAR-T infusions occurred in 2019 (66.6% in IP cohort and 74.0% in OP cohort). During the first month post-CAR-T infusion, OP cohort had significantly lower number of IP visits, IP days, ICU stays, and ICU days compared to the IP cohort. Average LOS per IP episode was 14.2 days in the IP cohort and 7.1 days in the OP cohort. Number of IP visits, IP days, and ICU days were nominally lower while number of OP visits were nominally higher in the OP cohort compared to the IP cohort in subsequent months (Table). Conclusions: Over 90% of the patients treated with CAR-T in the OP setting received tisa-cel. Patients receiving CAR-T in the OP setting had lower resource use of IP and ICU compared to patients receiving CAR-T in the IP setting.[Table: see text]

Alpha-1 Antitrypsin Deficiency-Associated Clinical Manifestations and Healthcare Resource Use in the United States

Pulmonary events (PEs) associated with alpha-1 antitrypsin deficiency (AATD) can have a severe clinical course and increase healthcare resource use (HRU). However, AATD-associated HRU and healthcare costs have not been extensively described. This study describes and compares real-world HRU and healthcare costs among US patients with severe (requiring hospitalization after AATD-related PE) versus nonsevere AATD clinical course. Administrative healthcare claims for patients with a second primary AATD diagnosis between 6/1/2008 and 12/31/2017 were analyzed from 2 databases (requiring continuous enrollment 6 months preceding diagnosis). Patient baseline characteristics and AATD-associated PE incidence rates, HRU, and healthcare costs during follow-up were compared in patients with severe versus nonsevere AATD. Of 5109 patients with a second AATD diagnosis, 2674 (severe, n = 711 [26.6%]; nonsevere, n = 1963 [73.4%]) had ≥1 AATD-associated PE. PE incidence per 100 person-years was higher in patients with severe versus nonsevere AATD. Annual incidences (mean ± SD) of emergency department (1.2 ± 5.7 vs. 0.4 ± 1.2), inpatient (1.3 ± 2.5 vs. 0.1 ± 0.5), and outpatient (10.3 ± 15.9 vs. 5.7 ± 13.2) visits were higher in patients with severe versus nonsevere AATD. Median (interquartile range) annual costs were also higher for patients with severe versus nonsevere AATD for emergency department ($185 [$0–$1665] vs. $0 [$0–$264]), inpatient ($16,038 [$2968–$70,941] vs. $0 [$0–$0]), and outpatient ($2663 [$412–$10,277] vs. $1114 [$134–$4195]) visits. Higher percentages of patients with severe AATD were prescribed augmentation therapy, antibiotics, or corticosteroids. These findings suggest that patients with severe AATD have higher incidence of AATD-associated PEs, as well as higher HRU and healthcare costs.

Health Resource Utilization and Costs Associated with the Use of Obinutuzumab-Based Regimens Are Similar to Rituximab-Based Regimens for the First-Line Treatment of Follicular Lymphoma

Introduction: Obinutuzumab (GA101; G), a fully humanized, glycoengineered, type II anti-CD20 monoclonal antibody, is approved in the US for the first-line (1L) treatment of follicular lymphoma (FL). Despite the superior efficacy of G plus chemotherapy (G-chemo) versus rituximab (R) plus chemotherapy (R-chemo) in patients with previously untreated FL demonstrated in the Phase III, randomized GALLIUM study (NCT01332968; Marcus et al. N Engl J Med 2017), information on healthcare resource use (HRU) and real-world costs with G in previously untreated FL patients is limited. The aim of this retrospective cohort study was to examine HRU and costs for G-based and R-based therapies for the 1L treatment of FL using a US claims database. Methods: The data source for this study was the PharMetrics Plus Commercial Claims database. Adult patients (≥18 years) diagnosed with FL between February 1, 2015 and September 30, 2018 and who began any treatment for FL between February 1, 2016 and September 30, 2018 were included. The first FL treatment date within this selection window was denoted the index date. Patients were required to have ≥12 months of pre-index and ≥3 months of post-index continuous study enrolment, and to have at least one FL diagnosis on or during the 12-month pre-index period. Patients with FL treatment during the 12-month pre-index period were excluded in order to select only previously untreated patients. HRU and cost data during the 1L treatment period were descriptive and categorized by HRU category. Costs are in 2018 US dollars ($) and standardized as per patient per month (PPPM) costs. FL treatment determination was based on National Comprehensive Cancer Network guidelines. Results: A total of 1584 FL patients with ≥3 months follow up were analyzed. Overall, 26 patients received G-chemo (any combination) as their 1L treatment, 208 patients received R-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), 391 patients received R-Benda (bendamustine) and 17 patients received R-CVP (cyclophosphamide, vincristine, prednisone); the remaining 942 patients received other regimens (predominantly other R combinations). Data are reported for those patients who received G-chemo, R-CHOP, R-Benda or R-CVP as 1L therapy (n=642; 281 females, 361 males). Baseline patient characteristics were similar for most variables across treatment groups. Mean (standard deviation [SD]) age was 56.9 (9.7) years and all patients had a Charlson Comorbidity Index (CCI) of ≥2 (mean [SD]: 2.9 [1.9]). Mean (SD) patient follow-up was 14.1 (8.0) months and mean (SD) duration of 1L treatment was 7.0 (5.1) months. A summary of all-cause HRU in patients receiving 1L treatment is provided by treatment category (Figure 1A). The proportion of patients with at least one hospitalization was highest with R-CHOP (23.6%). The proportion of patients with at least one emergency room (ER) visit was highest with R-Benda (29.4%). Mean (SD) total all-cause healthcare costs PPPM during 1L treatment were comparable among G-chemo, R-CHOP and R-Benda (Figure 1B) and lowest with R-CVP ($17,874 [$13,465]). Medical costs (mean [SD]) were highest for R-Benda ($27,716 [$19,610] PPPM) and lowest for R-CVP ($17,373 [$12,908] PPPM). G-chemo was associated with the lowest pharmacy costs ($76 [$107] PPPM) (Figure 1B). Mean (SD) total cost of FL drug treatment PPPM was $16,028 ($9,942) for G-chemo, $11,684 ($6,122) for R-CHOP and $12,108 ($8,794) for R-CVP. Mean (SD) total cost of FL drug treatment PPPM was highest with R-Benda ($21,263 [$15,328]). G-specific drug costs PPPM ($9,643 [$6,071]) were similar to R-specific drug costs ($9,992 [$5,234] R-CHOP; $9,083 [$5,859] R-Benda; and $10,702 [$7,717] R-CVP). Conclusions: Our results depict real-world HRU and costs associated with G and commonly used 1L regimens for FL. In this setting, HRU and costs associated with G-chemo were comparable with R-chemo, supporting the use of G-chemo as a treatment option for patients with previously untreated FL. The study findings are limited by the small sample size of the G-chemo patient cohort (n=26) and short follow-up; to address this, an updated analysis incorporating a larger number of patients is planned. Disclosures To: Genentech, Inc.: Employment, Equity Ownership. Dawson:Roche/Genentech: Equity Ownership; Genentech: Employment. Masaquel:Genentech: Employment; Roche: Equity Ownership. Seetasith:Genentech: Employment, Equity Ownership.

P.062 Burden of illness of spinal muscular atrophy (SMA): an update

Background: In this retrospective claims analysis, real-world healthcare resource use (HRU) and costs among SMA type 1 (SMA1) patients were assessed. Methods: SMA1 patients were identified from Symphony Health’s Integrated Dataverse® (09/01/2016–08/31/2018). The study period spanned from the index date (date of first SMA1 diagnosis after nusinersen approval [12/23/2016]) until death/end of available data. HRU and costs per-patient-per-year (PPPY; 2018USD) were described during the study period for all patients and after treatment initiation for nusinersen-treated patients. Results: A total of 349 SMA1 patients (median age=1 year; 55.6% female) with median follow-up of 7.9 months were included. The proportion of patients receiving mechanical ventilation, nutritional support, and physical therapy/rehabilitation was 46.4%, 46.1%, and 22.6%. Patients had, on average, 59.4 days with medical visits/year (14.1 inpatient, 13.4 respiratory failure-related). The 45 nusinersen-treated patients had, on average, 56.6 days with medical visits/year (4.6 inpatient, 11.4 respiratory failure-related). Excluding nusinersen-related costs, mean healthcare costs PPPY were $137,627 (median: $43,167) for all patients and $92,618 ($29,425) for nusinersen-treated patients. Mean nusinersen-related costs were $191,909 ($144,487) per month for the first 3 months post-initiation and $36,882 ($16,132) per month thereafter. Conclusions: HRU and costs associated with SMA1 are substantial, even among patients treated with nusinersen.

Health care resource use among patients with advanced non-small cell lung cancer: the PIvOTAL retrospective observational study

BackgroundData are scarce regarding real-world health care resource use (HCRU) for non-small cell lung cancer (NSCLC). An understanding of current clinical practices and HCRU is needed to provide a benchmark for rapidly evolving NSCLC management recommendations and therapeutic options. The objective of this study was to describe real-world HCRU for patients with advanced NSCLC.MethodsThis multinational, retrospective chart review study was conducted at academic and community oncology sites in Italy, Spain, Germany, Australia, Japan, South Korea, Taiwan, and Brazil. Deidentified data were drawn from medical records of 1440 adults (≥18 years old) who initiated systemic therapy (2011 to mid-2013) for a new, confirmed diagnosis of advanced or metastatic (stage IIIB or IV) NSCLC. We summarized HCRU associated with first and subsequent lines of systemic therapy for advanced/metastatic NSCLC.ResultsThe proportion of patients who were hospitalized at least once varied by country from 24% in Italy to 81% in Japan during first-line therapy and from 22% in Italy to 84% in Japan during second-line therapy; overall hospitalization frequency was 2.5–11.1 per 100 patient-weeks, depending on country. Emergency visit frequency also varied among countries (overall from 0.3–5.9 per 100 patient-weeks), increasing consistently from first- through third-line therapy in each country. The outpatient setting was the most common setting of resource use. Most patients in the study had multiple outpatient visits in association with each line of therapy (overall from 21.1 to 59.0 outpatient visits per 100 patient-weeks, depending on country). The use of health care resources showed no regular pattern associated with results of tests for activating mutations of the epidermal growth factor receptor (EGFR) gene or anaplastic lymphoma kinase (ALK) gene rearrangements.ConclusionsHCRU varied across countries. These findings suggest differing approaches to the clinical management of advanced NSCLC among the eight countries. Comparative findings and an understanding of country-specific clinical practices can help to identify areas of need and guide future resource allocation for patients with advanced NSCLC. Further studies evaluating the costs associated with resource use are warranted.

A Multi-Centre Retrospective Study To Describe The Impact on Healthcare Resource Use And Real World Effectiveness of Golimumab In Ankylosing Spondylitis (AS) In UK Clinical Practice

Objectives Study aims were to describe the impact of Tumour Necrosis Factor-α (TNF-α) inhibitor golimumab on UK real-world healthcare resource use (HRU) and evaluate the clinical effectiveness of golimumab in the treatment of Ankylosing Spondylitis (AS). This abstract presents HRU data for the 6 months pre- and post-golimumab initiation as well as effectiveness data at 6 months post-golimumab initiation compared with the closest observation pre-golimumab initiation. Methods This multicentre observational study of consenting adult patients was carried out via retrospective medical chart review in six UK NHS hospital rheumatology departments between November 2015 and October 2016. Inclusion criteria included AS diagnosis, anti-TNF-α-naive, received minimum three doses of golimumab for AS, and first dose at least 12 months before data collection. Effectiveness was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Spinal Pain Visual Analogue Scale (VAS) and Bath Ankylosing Spondylitis Functional Index (BASFI). Patients with missing data are excluded from the effectiveness analysis. Results The study enrolled 47 eligible patients, 74% male, mean age of 46.4 years, mean golimumab treatment duration of 2.3 years. A significant reduction of 30.4% (Mann-Whitney p<0.005) in mean number of rheumatology clinic visits (from 2.3 to 1.6) and a 27.3% reduction in mean number of clinical investigations (from 13.4 to 9.7) over the 12-month period was observed (Mann-Whitney p<0.05). 74% (32/43) of patients achieved a clinically meaningful change (BASDAI score reduced by 2 or more), and overall mean BASDAI score reduced by 3.9 points [n=43] (Mann-Whitney p<0.001). 75% (18/24) of patients achieved a reduction in spinal pain VAS by 2cm or more indicating a treatment response. Overall mean BASFI score improved by 4.1 points [n=26] (Mann-Whitney p<0.001). Conclusions Golimumab was associated with statistically significant reductions in HRU and clinically meaningful improvements in UK patients with AS during the first 6 months of treatment.

Prehospital and in-hospital use of healthcare resources in patients surviving acute coronary syndromes: an analysis of the EPICOR registry

ObjectiveThe aim of this report is to provide insight into real-world healthcare resource use (HCRU) during the critical management of patients surviving acute coronary syndromes (ACS), using data from EPICOR...

Health care resource use (HRU) with nonplatinum chemotherapy for previously treated advanced ovarian cancer (aOC): Findings from SEER-Medicare data.

e15539 Background: Real world HRU in second-line aOC has not been well quantified. The objective of this study was to assess HRU and treatment patterns in women with previously-treated aOC subsequently treated with nonplatinum chemotherapy (CT). Methods: A retrospective study was conducted using the SEER-Medicare linked dataset. The population included women ≥ 65 years who were diagnosed with incident, distant-stage aOC between 1993-2005 and who had ≥ 3 months of claims data before diagnosis. The study cohort included patients previously treated with platinum-based CT and re-treated following a ≥ 90 day treatment-free interval (TFI) with nonplatinum-based CT in 2000-2005. Patients were followed from the first claim for retreatment with a nonplatinum CT regimen until either death or the end of the claims data (12/31/2007). Measures of HRU included hospitalizations, outpatient visits, physician visits, hospice care, home health care, and skilled nursing facility (SNF) visits. Costs of each HRU event were estimated by summing all Medicare payments, primary insurer payments, patient copayments and deductibles for services in the claims files. Average healthcare costs per patient per event type (e.g., hospitalization) are calculated as total event cost per event divided by number of patients with the event. Results: 2,166 previously treated aOC patients subsequently received nonplatinum CT as second-line therapy. Mean age was 74.0 years (SD 5.6). The mean treatment duration in the non- platinum CT period was 317 days (SD 354). Paclitaxel and pegylated liposomal doxorubicin (PLD) were the most commonly used nonplatinum CT agents. Paclitaxel use declined from 38.1% to 30.0% while PLD use increased from 16.4% to 26.8% from 2000-2005. Rate of hospitalization was 1.3 per person-year. Mean hospitalization cost per patient was $10,466 (SD $10,846). Mean SNF and hospice care costs per patient were $7,416 (SD $6,907) and $6,955 (SD $11,416) respectively. Conclusions: Both paclitaxel and PLD were frequently used nonplatinum-based CTs in women with aOC who were previously treated with platinum-based agents. Hospitalization costs per patient were substantial. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen Amgen Amgen