Significant HCRU and Cost Burden for Patients With AML Who Relapse

The majority of patients with acute myeloid leukemia (AML) relapse after first-line treatment, which is associated with substantial health care resource utilization (HCRU) and cost burden. These patients also have a poor prognosis: the median survival after relapse is 4 to 11 months.

A retrospective analysis presented at the Virtual ISPOR 2021 meeting highlighted the substantial HCRU burden and costs in the United States and found that 82% of the costs in the first 12 months after relapse comprise inpatient resource utilization.

“Characterizing hospitalization patterns and associated costs of relapsed AML is important for understanding the burden of relapsed AML and the potential clinical and economic benefits of therapies for AML,” the authors wrote.

The researchers used data from the Premier Healthcare Database to examine annual HCRU and associated costs for patients with diagnosed relapsed AML. The database is a large, geographically diverse, hospital-based, all-payer database containing the administrative, health care utilization, and cost data from more than 1 billion patient encounters from more than 1041 hospitals.

The study included 2290 patients with relapsed AML. To be included, patients needed to be ≥ 18 years; have a relapsed AML diagnosis between January 1, 2016, and March 31, 2019; have a prior visit to the same hospital within 2 years; have no relapsed AML diagnosis in the 2 years before the index period (the relapse date); have no stem cell transplantation in the 2 years before the index period; and have no missing billing records.

The mean (SD) age of the patients included was 61.2 (15.7) years, and approximately half (50.2%) were ≥ 65 years. The majority were male (53.1%), White (77.8%), and on Medicare (51.2%). The mean Charlson Comorbidity Index score was 4.02 (2.66) and the most common condition was diabetes (31.0%), followed by congestive heart failure (19.5%) and chronic obstructive pulmonary disease (19.0%).

In the first 12 months after relapse, patients incurred 1798 inpatient hospitalizations:

• Mean 2.4 hospitalizations per patient
• Mean length of stay of 13.4 days
• 1674 outpatient visits
• 30.8% of inpatient admissions were intensive care unit (ICU) admissions
• Mean length of stay for ICU admissions was 5.2 days

The mean (SD) cost per visit was $34,209 ($33,838) for inpatient admissions, $19,050 ($19,019) for ICU admissions, and $1793 ($1964) for outpatient visits. In addition, the total cost for patients with AML relapse was $169,643,544.

Slightly less than half (48.4%) had an elective admission, which meant their “condition permitted adequate time to schedule the availability of a suitable accommodation,” while 29.9% were considered emergency, 17.6% urgent, and 4.1% other.

Most (69.4%) patients were discharged home after the visit; however, 6.4% died in the hospital. In addition, 6.4% were discharged to hospice care and 6.3% were transferred to another facility. For 11.2% of the patients, the discharge was other or unknown. The mean length of follow-up was 187 days for patients.

“This study demonstrates significant disease burden, which suggests the need for therapies that would delay relapse and improve survival in patients with AML,” the researchers concluded.

Reference

Huggar D, Knoth R, Cao Z, Lipkin C, Copher R, LeBlanc TW. Annual healthcare resource utilization and costs in US patients diagnosed with relapsed acute myeloid leukemia. Presented at: Virtual ISPOR 2021; May 17-20. Poster PCN51.