Contributions
Abstract: PB1520
Type: Publication Only
Session title: Chronic myeloid leukemia - Clinical
Background
TKIs are the standard of care for the treatment of chronic phase CML under National Comprehensive Cancer Network (NCCN) guidelines. Imatinib is recommended as a first-generation TKI (1GTKI), and bosutinib, dasatinib, nilotinib, and ponatinib are recommended as second-generation TKIs (2GTKIs). TKIs are associated with high healthcare resource utilization (HRU) and costs, although literature is limited comparing 1GTKI and 2GTKIs in a U.S. population.
Aims
To assess clinical and economic burden of first-generation and second-generation TKIs in CML patients
Methods
Using the Veteran’s Health Administration (VHA) database between April 1, 2013 and March 31, 2018, the study included patients aged ≥18 years with ≥1 medical claim for CML and ≥1 prescription claim for a TKI on or after the initial CML diagnosis date during the identification period (October 1, 2014 to September 30, 2017); the first TKI prescription claim was defined as the index date. Inverse probability of treatment weighting (IPTW) minimized potential confounding; included variables were age, race, Quan-Charlson Comorbidity Index (CCI) score, and CHA2DS2-VASc Score. Medication possession ratio (MPR) assessed adherence to index TKI; optimal adherence was defined as MPR ≥80%.
Results
944 patients were included: 78.9% on 1GTKI and 21.1% on 2GTKI. Mean age was 62.21 years (SD:18.8); 77.2% were white. At baseline, patients on 1GTKI had a higher comorbidity burden than 2GTKIs: COPD (19.7% vs. 8%; p<0.01), anemia (17.7% vs. 11.1%; p=0.02), GI symptoms (28.5% vs. 18.6%; p<0.01), cardiac dysrhythmias (15.6% vs. 7.5%; p<0.01), coronary artery disease (26.3% vs. 13.6%; p<0.01), hypertension (55.7% vs. 43.2%; p<0.01) and CHA2DS2-VASc Score (2.2 vs 1.6; p<0.01). Optimal adherence was higher with 1GTKI (69.6% vs. 62.2%; p=0.04), although this was not statistically significant when mean MPR was compared. During follow-up, no difference between 1GTKI and 2GTKIs patients occurred with cardiac-related risk factors or CHA2DS2-VASc Score. Compared to 1GTKI, 2GTKIs had lower medical (inpatient and outpatient) costs ($3,162 vs. $3,906; p=0.04) but higher all-cause pharmacy cost ($7,214 vs. $3,895; p<0.01) due to imatinib becoming a generic drug during the study period. CML-related ($2,260 vs. $1,640, p<0.01) and cardiac-related medical costs ($1,365 vs. $665, p<0.01) were significantly higher in 1GTKI vs. 2GTKIs patients.
Conclusion
Adherence to TKI therapy was suboptimal for both 1GTKI and 2GTKIs. 2GTKIs incurred lower medical cost in comparison to 1GTKI. Differences in total all-cause cost was primarily driven by pharmacy cost of TKIs. These results show that, beyond the cost of the TKI, using a 2GTKIs in the first-line can lead to cost offsets when compared to imatinib.
Keyword(s): Chronic myeloid leukemia, Clinical outcome, Cost analysis, Tyrosine kinase inhibitor
Abstract: PB1520
Type: Publication Only
Session title: Chronic myeloid leukemia - Clinical
Background
TKIs are the standard of care for the treatment of chronic phase CML under National Comprehensive Cancer Network (NCCN) guidelines. Imatinib is recommended as a first-generation TKI (1GTKI), and bosutinib, dasatinib, nilotinib, and ponatinib are recommended as second-generation TKIs (2GTKIs). TKIs are associated with high healthcare resource utilization (HRU) and costs, although literature is limited comparing 1GTKI and 2GTKIs in a U.S. population.
Aims
To assess clinical and economic burden of first-generation and second-generation TKIs in CML patients
Methods
Using the Veteran’s Health Administration (VHA) database between April 1, 2013 and March 31, 2018, the study included patients aged ≥18 years with ≥1 medical claim for CML and ≥1 prescription claim for a TKI on or after the initial CML diagnosis date during the identification period (October 1, 2014 to September 30, 2017); the first TKI prescription claim was defined as the index date. Inverse probability of treatment weighting (IPTW) minimized potential confounding; included variables were age, race, Quan-Charlson Comorbidity Index (CCI) score, and CHA2DS2-VASc Score. Medication possession ratio (MPR) assessed adherence to index TKI; optimal adherence was defined as MPR ≥80%.
Results
944 patients were included: 78.9% on 1GTKI and 21.1% on 2GTKI. Mean age was 62.21 years (SD:18.8); 77.2% were white. At baseline, patients on 1GTKI had a higher comorbidity burden than 2GTKIs: COPD (19.7% vs. 8%; p<0.01), anemia (17.7% vs. 11.1%; p=0.02), GI symptoms (28.5% vs. 18.6%; p<0.01), cardiac dysrhythmias (15.6% vs. 7.5%; p<0.01), coronary artery disease (26.3% vs. 13.6%; p<0.01), hypertension (55.7% vs. 43.2%; p<0.01) and CHA2DS2-VASc Score (2.2 vs 1.6; p<0.01). Optimal adherence was higher with 1GTKI (69.6% vs. 62.2%; p=0.04), although this was not statistically significant when mean MPR was compared. During follow-up, no difference between 1GTKI and 2GTKIs patients occurred with cardiac-related risk factors or CHA2DS2-VASc Score. Compared to 1GTKI, 2GTKIs had lower medical (inpatient and outpatient) costs ($3,162 vs. $3,906; p=0.04) but higher all-cause pharmacy cost ($7,214 vs. $3,895; p<0.01) due to imatinib becoming a generic drug during the study period. CML-related ($2,260 vs. $1,640, p<0.01) and cardiac-related medical costs ($1,365 vs. $665, p<0.01) were significantly higher in 1GTKI vs. 2GTKIs patients.
Conclusion
Adherence to TKI therapy was suboptimal for both 1GTKI and 2GTKIs. 2GTKIs incurred lower medical cost in comparison to 1GTKI. Differences in total all-cause cost was primarily driven by pharmacy cost of TKIs. These results show that, beyond the cost of the TKI, using a 2GTKIs in the first-line can lead to cost offsets when compared to imatinib.
Keyword(s): Chronic myeloid leukemia, Clinical outcome, Cost analysis, Tyrosine kinase inhibitor