Contributions
Abstract: EP1107
Type: E-Poster Presentation
Session title: Myeloproliferative neoplasms - Clinical
Background
Myeloproliferative neoplasms (MPNs) are associated with severe complications and a substantial symptom burden – frequently emerging several years before diagnosis. Due to the chronic nature of the diseases, MPN patients have a lifelong need for treatment and care. However, only few studies have assessed MPN healthcare resource utilization (HRU) compared with matched cohorts, and no detailed assessments of HRU in the years preceding MPN diagnosis exist.
Aims
To assess the pre- and post-diagnostic HRU of MPN patients compared with matched cohorts of nonMPN comparisons.
Methods
We conducted this descriptive, register-based nationwide cohort study, utilizing data from the Danish National Chronic Myeloid Neoplasia Registry on all MPN patients diagnosed between January 2010 and December 2016, and data on HRU from the Danish National Patient Registry and the Danish National Health Service Registry. Population-based cohorts of nonMPN comparisons were constructed by 1:10 matching on age, sex, level of education, and region of residence. Data were linked using the unique civil registration number, which identifies all Danish citizens. HRU was summarized over each year for all cohorts from two years before date of MPN diagnosis and until emigration, death, or end of study (31 December 2017). HRU was calculated as annual number of healthcare contacts (inpatient days, outpatient consultations, treatments and examinations, and general practitioner [GP] visits) divided by person-years at risk and compared using rate ratios with 95% CI.
Results
The study population included 3,342 MPN patients (1,140 essential thrombocythemia [ET]; 1,109 polycythemia vera [PV]; 533 primary myelofibrosis [PMF]; and 560 unspecified MPN [MPN-U]) and 32,737 nonMPN comparisons (11,181 nonET; 10,873 nonPV; 5,217 nonPMF; and 5,466 nonMPN-U). The median age was 67 (ET), 69 (PV), 73 (PMF), and 72 years (MPN-U), and the mean follow-up was 3.8 (ET), 3.8 (PV), 3.1 (PMF), and 3.3 years (MPN-U). A total of 750 (22.4%) MPN patients and 4,627 (14.1%) nonMPN comparisons died during follow-up. In nearly all years of follow-up, MPN patients had a higher HRU than nonMPN comparisons (Figure, rate ratio>1). Rate ratios for outpatient consultations were largest at the time of diagnosis: ET, 2.7 (95%CI, 2.6-2.9); PV, 3.4 (95%CI, 3.2-3.6); PMF, 4.0 (95%CI, 3.7-4.4); and MPN-U, 3.7 (95%CI, 3.4-4.0). For most MPN subtypes, rate ratios also peaked at time of diagnosis for treatment and examinations. In contrast, the largest rate ratio for PV was in the last year of follow-up: 3.5 (95%CI, 2.8-4.3). Across MPN subtypes, rate ratios for GP visits varied from 1.0 to 1.5 during follow-up without any considerable fluctuations. Interestingly, increased rate ratios for inpatients days were evident 2 years before diagnosis: ET, 1.8 (95%CI, 1.7-1.9); PV, 1.3, (95%CI, 1.2-1.3); PMF, 1.4 (95%CI, 1.2-1.5); and MPN-U, 1.7 (95%CI, 1.6-1.9). During follow-up, notable increases in rate ratios were observed, e.g., PMF 3.0 (95%CI 2.4-3.6) and PV 3.8 (95%CI 3.0-4.8) in year 5 and 7, respectively.
Conclusion
Overall, compared with matched nonMPN comparisons, MPN patients had a higher HRU throughout the study period. This was consistent across MPN subtypes and HRU measures. Within the limitations of small numbers toward end of follow-up and lack of matching on comorbidity, our findings confirmed a consistent HRU burden after MPN diagnosis. Equally important, our study revealed substantial increases in HRU two years before MPN diagnosis, warranting further exploration of the pre-diagnostic period, including the potential benefits of early detection.
Keyword(s): Cost analysis, Epidemiology, Health care, Myeloproliferative disorder
Abstract: EP1107
Type: E-Poster Presentation
Session title: Myeloproliferative neoplasms - Clinical
Background
Myeloproliferative neoplasms (MPNs) are associated with severe complications and a substantial symptom burden – frequently emerging several years before diagnosis. Due to the chronic nature of the diseases, MPN patients have a lifelong need for treatment and care. However, only few studies have assessed MPN healthcare resource utilization (HRU) compared with matched cohorts, and no detailed assessments of HRU in the years preceding MPN diagnosis exist.
Aims
To assess the pre- and post-diagnostic HRU of MPN patients compared with matched cohorts of nonMPN comparisons.
Methods
We conducted this descriptive, register-based nationwide cohort study, utilizing data from the Danish National Chronic Myeloid Neoplasia Registry on all MPN patients diagnosed between January 2010 and December 2016, and data on HRU from the Danish National Patient Registry and the Danish National Health Service Registry. Population-based cohorts of nonMPN comparisons were constructed by 1:10 matching on age, sex, level of education, and region of residence. Data were linked using the unique civil registration number, which identifies all Danish citizens. HRU was summarized over each year for all cohorts from two years before date of MPN diagnosis and until emigration, death, or end of study (31 December 2017). HRU was calculated as annual number of healthcare contacts (inpatient days, outpatient consultations, treatments and examinations, and general practitioner [GP] visits) divided by person-years at risk and compared using rate ratios with 95% CI.
Results
The study population included 3,342 MPN patients (1,140 essential thrombocythemia [ET]; 1,109 polycythemia vera [PV]; 533 primary myelofibrosis [PMF]; and 560 unspecified MPN [MPN-U]) and 32,737 nonMPN comparisons (11,181 nonET; 10,873 nonPV; 5,217 nonPMF; and 5,466 nonMPN-U). The median age was 67 (ET), 69 (PV), 73 (PMF), and 72 years (MPN-U), and the mean follow-up was 3.8 (ET), 3.8 (PV), 3.1 (PMF), and 3.3 years (MPN-U). A total of 750 (22.4%) MPN patients and 4,627 (14.1%) nonMPN comparisons died during follow-up. In nearly all years of follow-up, MPN patients had a higher HRU than nonMPN comparisons (Figure, rate ratio>1). Rate ratios for outpatient consultations were largest at the time of diagnosis: ET, 2.7 (95%CI, 2.6-2.9); PV, 3.4 (95%CI, 3.2-3.6); PMF, 4.0 (95%CI, 3.7-4.4); and MPN-U, 3.7 (95%CI, 3.4-4.0). For most MPN subtypes, rate ratios also peaked at time of diagnosis for treatment and examinations. In contrast, the largest rate ratio for PV was in the last year of follow-up: 3.5 (95%CI, 2.8-4.3). Across MPN subtypes, rate ratios for GP visits varied from 1.0 to 1.5 during follow-up without any considerable fluctuations. Interestingly, increased rate ratios for inpatients days were evident 2 years before diagnosis: ET, 1.8 (95%CI, 1.7-1.9); PV, 1.3, (95%CI, 1.2-1.3); PMF, 1.4 (95%CI, 1.2-1.5); and MPN-U, 1.7 (95%CI, 1.6-1.9). During follow-up, notable increases in rate ratios were observed, e.g., PMF 3.0 (95%CI 2.4-3.6) and PV 3.8 (95%CI 3.0-4.8) in year 5 and 7, respectively.
Conclusion
Overall, compared with matched nonMPN comparisons, MPN patients had a higher HRU throughout the study period. This was consistent across MPN subtypes and HRU measures. Within the limitations of small numbers toward end of follow-up and lack of matching on comorbidity, our findings confirmed a consistent HRU burden after MPN diagnosis. Equally important, our study revealed substantial increases in HRU two years before MPN diagnosis, warranting further exploration of the pre-diagnostic period, including the potential benefits of early detection.
Keyword(s): Cost analysis, Epidemiology, Health care, Myeloproliferative disorder