Contributions
Abstract: PB1633
Type: Publication Only
Background
Adult ALL is a rare but frequently fatal disease. Many patients who respond to initial therapy experience a relapse. For relapsed ALL (rALL), hematopoietic stem cell transplant (HSCT) is a potentially curative treatment option. HSCT is associated with added costs, however, which could impact overall healthcare budget.
Aims
This retrospective observational study aims to determine the cost of care and the impact of HSCT on total cost for adult rALL patients from a German payers’ perspective.
Methods
A German claims database with a representative sample of approximately 7 million individuals insured within the German statutory health insurance and continuously observable over a period of 6 years was used as data source. From these data, adult patients (18 years and older) with a new diagnosis of ALL (ICD-10-GM code: C91.0*) between January 1, 2011 and December 31, 2015 and a relapse after remission to initial treatment were identified. Mean health care cost per patient per quarter, the smallest unit of time available in the database, was determined by whether or not patients had an HSCT after relapse. Costs were considered from the perspective of the German statutory health insurance and included costs for prescription medicine as well as outpatient and inpatient healthcare encounters.
Results
Of the total 116 incident adult ALL patients identified, 29 (25%) were determined to have had a relapse and 11 underwent HSCT after relapse (38%). Patients with an HSCT appear to incur higher cost than those without HSCT in each of the quarters after relapse was diagnosed (Table), with the highest in the first quarter after relapse, but decreasing in subsequent quarters. Inpatient cost accounted for the majority of the cost for the first three quarters for both HSCT and non-HSCT patients, but more for HSCT patients. The number of patients in the HSCT cohort remained relatively stable, while the non-HSCT cohort had only half the patients left by the third quarter post relapse.
Patient group | Index quarter (relapse) | Q1 | Q2 | Q3 | |||||||||
N | mean | % Inpatient cost | N | mean | % Inpatient cost | N | mean | % Inpatient cost | N | mean | % Inpatient cost | ||
rALL without HSCT | 18 | 34,616 | 84% | 18 | 23,228 | 83% | 11 | 10,762 | 61% | 9 | 11,194 | 73% | |
rALL with HSCT | 11 | 38,057 | 79% | 10 | 54,559 | 88% | 9 | 25,972 | 65% | 9 | 27,055 | 88% | |
Total | 29 | 35,921 | 82% | 28 | 34,417 | 86% | 20 | 17,606 | 64% | 18 | 19,125 | 84% | |
Conclusion
The results of this study inform the magnitude of cost in Germany associated with adult rALL patients with or without an HSCT after relapse. The cost estimates provide a benchmark against which new treatment options for rALL can be compared. For future studies, it would be important to determine the magnitude of benefit such as long-term survival and other health consequences associated with HSCT as well.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Relapsed acute lymphoblastic leukemia, Cost analysis, Autologous hematopoietic stem cell transplantation
Abstract: PB1633
Type: Publication Only
Background
Adult ALL is a rare but frequently fatal disease. Many patients who respond to initial therapy experience a relapse. For relapsed ALL (rALL), hematopoietic stem cell transplant (HSCT) is a potentially curative treatment option. HSCT is associated with added costs, however, which could impact overall healthcare budget.
Aims
This retrospective observational study aims to determine the cost of care and the impact of HSCT on total cost for adult rALL patients from a German payers’ perspective.
Methods
A German claims database with a representative sample of approximately 7 million individuals insured within the German statutory health insurance and continuously observable over a period of 6 years was used as data source. From these data, adult patients (18 years and older) with a new diagnosis of ALL (ICD-10-GM code: C91.0*) between January 1, 2011 and December 31, 2015 and a relapse after remission to initial treatment were identified. Mean health care cost per patient per quarter, the smallest unit of time available in the database, was determined by whether or not patients had an HSCT after relapse. Costs were considered from the perspective of the German statutory health insurance and included costs for prescription medicine as well as outpatient and inpatient healthcare encounters.
Results
Of the total 116 incident adult ALL patients identified, 29 (25%) were determined to have had a relapse and 11 underwent HSCT after relapse (38%). Patients with an HSCT appear to incur higher cost than those without HSCT in each of the quarters after relapse was diagnosed (Table), with the highest in the first quarter after relapse, but decreasing in subsequent quarters. Inpatient cost accounted for the majority of the cost for the first three quarters for both HSCT and non-HSCT patients, but more for HSCT patients. The number of patients in the HSCT cohort remained relatively stable, while the non-HSCT cohort had only half the patients left by the third quarter post relapse.
Patient group | Index quarter (relapse) | Q1 | Q2 | Q3 | |||||||||
N | mean | % Inpatient cost | N | mean | % Inpatient cost | N | mean | % Inpatient cost | N | mean | % Inpatient cost | ||
rALL without HSCT | 18 | 34,616 | 84% | 18 | 23,228 | 83% | 11 | 10,762 | 61% | 9 | 11,194 | 73% | |
rALL with HSCT | 11 | 38,057 | 79% | 10 | 54,559 | 88% | 9 | 25,972 | 65% | 9 | 27,055 | 88% | |
Total | 29 | 35,921 | 82% | 28 | 34,417 | 86% | 20 | 17,606 | 64% | 18 | 19,125 | 84% | |
Conclusion
The results of this study inform the magnitude of cost in Germany associated with adult rALL patients with or without an HSCT after relapse. The cost estimates provide a benchmark against which new treatment options for rALL can be compared. For future studies, it would be important to determine the magnitude of benefit such as long-term survival and other health consequences associated with HSCT as well.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Relapsed acute lymphoblastic leukemia, Cost analysis, Autologous hematopoietic stem cell transplantation