Significant Economic Burden Associated With Various AML Treatment Episodes

There is a substantial economic burden associated with multiple acute myeloid leukemia (AML) treatment episodes, according to an analysis presented at the 59th Annual Meeting of the American Society of Hematology in Atlanta, Georgia.

AML is estimated to affect over 20,000 people in the United States in 2017, according to the authors of the analysis.

“Detailed real-world cost estimates and comparisons of key AML treatment episodes such as high-intensity chemotherapy (HIC), low-intensity chemotherapy (LIC), hematopoietic stem cell transplant (HSCT) and relapsed-refractory (R/R) patient episodes in the US commercially insured population are scarce and difficult to assemble,” wrote the authors.

The authors examined a large US healthcare claims database, PharMetrics Plus, and linked charge detail master (CDM) hospital data to identify patients with an AML diagnosis between January 1, 2008, and March 31, 2016. Patients with 2 or more outpatient claims or 1 or more inpatient claims were included.

Participants were required to have continuous health plan enrollment for ≥ 6 months pre and ≥ 3 months post the first diagnosis date. The authors evaluated:

• HIC induction: evidence of inpatient high dose cytarabine+anthracycline use within 3 months of diagnosis
• HIC consolidation: evidence of cytarabine +/- anthracycline use within 2 months following prior HIC
• LIC: evidence of low-intensity cytarabine, anthracycline, 5-azacytidine, decitabine, clofarabine, hydroxyurea or gemtuzumab ozogamicin in the outpatient setting within 3 months of diagnosis
• HSCT: transplant specific diagnosis/procedure codes
• R/R patients: record of an ICD-9 diagnosis code (205.02) for relapsed AML after a prior treatment of HIC, LIC, or HSCT

The study consisted of 1542 HIC induction, 591 consolidation, 628 LIC, 1000 HSCT, and 119 R/R patients. The total mean (SD) episode cost was the highest among HSCT patients, costing $329,621; followed by HIC induction cost of $198,528; R/R cost of $145,634; and HIC consolidation cost of $73,304. The lowest episode cost was associated with LIC ($53,081).

Other findings included:

• Hospitalization costs accounted for $244,801 for HSCT.
• All HIC induction required hospitalization and accounted for most of the HIC cost, with $2843 attributed to physician’s office visits and $2868 attributed to outpatient pharmacy.
• Hospitalization occurred in 74.8% of R/R patients at a cost of $101,420; physician's office visits costs were $3340, and outpatient pharmacy costs were $6108.
• Although LIC patients had a relatively low hospitalization rate (35.8%), hospitalization was a major cost contributor at $17,764.

“This resource utilization and direct healthcare cost analysis establishes a substantial economic burden associated with various AML treatment episodes, notable during the HIC induction, HSCT and R/R episodes in the US,” concluded the authors. “Hospitalization is a major cost driver across all episodes. New therapeutic strategies associated with less economic burden are needed.”

The meeting takes place from December 9-12, 2017.