Contributions
Abstract: PB1833
Type: Publication Only
Background
The prognosis of CML, the most common myeloproliferative syndrome, has improved considerably with the development of selective tyrosine kinase inhibitors (TKI) targeted to BCR-ABL. The ADAGIO study demonstrated the existence of treatment adherence issues under TKI. In addition, there is a correlation between adherence to treatment and major molecular response (MMR) under TKI. However, the understanding of treatment is a major element of adherence. One of the possible ways to achieve this understanding is therapeutic patient education (TPE).
Aims
Within our cancer centre, an TPE program on ITK in the management of CML has been authorized since 2011. We conducted a pharmacoeconomic study to evaluate the TPE clinical impact on responses to TKI in patients with CML (based on recommendations from European Leukemia Net) and also the costs in terms of use of care.
Methods
Over the 12-month follow-up period, the study population consisted of 2 groups of CML patients monitored in our centre: - Intervention group (n = 18) (IG) : Patients who benefited of TPE sessions on TKI between January 2013 and August 2015 - 'Matched controls' group (n = 18) (CG): Patients who benefited only from the usual care, matched to the 'Intervention' group. The method of pairing the 2 groups of patients according to the age at diagnosis, sex, the molecule used in first line and the prognostic risk according to the score of Sokal was used. The main criterion of efficacy was the MMR. The considered costs were: the cost of the TPE program, estimated on the basis of the French health insurance reimbursement per patient and the costs associated with the use of 'supplementary' care (examinations, consultations and additional hospitalizations). The point of view was from French health insurance.
Results
Over the 12-month follow-up period, the number of patients in MMR was similar between the 2 groups (9 in IG versus 8 in CG). However, the average time to obtain the MMR was significantly shorter in IG (6.9 months ± 3.8) than in CG (11.3 months ± 2.1) (p <0.05). The mean duration of MMR maintenance over the 12-month follow-up period was significantly longer in IG (3.2 months ± 3.5) than in CG (1.5 months ± 1.9) (p <0.05). Regarding the use of additional care, unexpected hospitalizations were significantly more numerous in CG than in IG (4 versus 0). Thus, costs associated with use of additional care were significantly lower in IG (€ 3,566) than in CG (€ 12,709). Thus, € 250 invested (annual allowance per patient) in the TPE saves € 508 in the use of care and reduces the time required to obtain a MMR by 4.4 months.
Conclusion
Thus, TPE is clinically and economically beneficial in our study population. By increasing the patient capacity to adapt to the treatment through the development of skills and adaptation processes, TPE reduces the costs of seeking care while improving the clinical response to treatment with a faster and more sustainable major molecular response.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Tyrosine kinase inhibitor, Molecular response, Chronic myeloid leukemia
Abstract: PB1833
Type: Publication Only
Background
The prognosis of CML, the most common myeloproliferative syndrome, has improved considerably with the development of selective tyrosine kinase inhibitors (TKI) targeted to BCR-ABL. The ADAGIO study demonstrated the existence of treatment adherence issues under TKI. In addition, there is a correlation between adherence to treatment and major molecular response (MMR) under TKI. However, the understanding of treatment is a major element of adherence. One of the possible ways to achieve this understanding is therapeutic patient education (TPE).
Aims
Within our cancer centre, an TPE program on ITK in the management of CML has been authorized since 2011. We conducted a pharmacoeconomic study to evaluate the TPE clinical impact on responses to TKI in patients with CML (based on recommendations from European Leukemia Net) and also the costs in terms of use of care.
Methods
Over the 12-month follow-up period, the study population consisted of 2 groups of CML patients monitored in our centre: - Intervention group (n = 18) (IG) : Patients who benefited of TPE sessions on TKI between January 2013 and August 2015 - 'Matched controls' group (n = 18) (CG): Patients who benefited only from the usual care, matched to the 'Intervention' group. The method of pairing the 2 groups of patients according to the age at diagnosis, sex, the molecule used in first line and the prognostic risk according to the score of Sokal was used. The main criterion of efficacy was the MMR. The considered costs were: the cost of the TPE program, estimated on the basis of the French health insurance reimbursement per patient and the costs associated with the use of 'supplementary' care (examinations, consultations and additional hospitalizations). The point of view was from French health insurance.
Results
Over the 12-month follow-up period, the number of patients in MMR was similar between the 2 groups (9 in IG versus 8 in CG). However, the average time to obtain the MMR was significantly shorter in IG (6.9 months ± 3.8) than in CG (11.3 months ± 2.1) (p <0.05). The mean duration of MMR maintenance over the 12-month follow-up period was significantly longer in IG (3.2 months ± 3.5) than in CG (1.5 months ± 1.9) (p <0.05). Regarding the use of additional care, unexpected hospitalizations were significantly more numerous in CG than in IG (4 versus 0). Thus, costs associated with use of additional care were significantly lower in IG (€ 3,566) than in CG (€ 12,709). Thus, € 250 invested (annual allowance per patient) in the TPE saves € 508 in the use of care and reduces the time required to obtain a MMR by 4.4 months.
Conclusion
Thus, TPE is clinically and economically beneficial in our study population. By increasing the patient capacity to adapt to the treatment through the development of skills and adaptation processes, TPE reduces the costs of seeking care while improving the clinical response to treatment with a faster and more sustainable major molecular response.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Tyrosine kinase inhibitor, Molecular response, Chronic myeloid leukemia