Overall survival, adverse events, and economic burden in patients with chronic lymphocytic leukemia receiving systemic therapy: Real‐world evidence from the medicare population

Autor: James A. Kaye, Hannah Le, Shaum M Kabadi, Saurabh P Nagar, Ravi K. Goyal, Keith L. Davis
Rok vydání: 2021
Předmět:
Male
0301 basic medicine
Cancer Research
costs
0302 clinical medicine
Cost of Illness
Antineoplastic Combined Chemotherapy Protocols
Original Research
Aged
80 and over
education.field_of_study
Incidence (epidemiology)
Health Care Costs
Middle Aged
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
treatment patterns
Oncology
030220 oncology & carcinogenesis
Female
medicine.drug
Adult
Bendamustine
medicine.medical_specialty
overall survival
Population
Neutropenia
Medicare
lcsh:RC254-282
Drug Costs
03 medical and health sciences
Internal medicine
medicine
Humans
Radiology
Nuclear Medicine and imaging
education
Adverse effect
Aged
Retrospective Studies
Chlorambucil
business.industry
Clinical Cancer Research
Retrospective cohort study
medicine.disease
Leukemia
Lymphocytic
Chronic
B-Cell
adverse events
United States
Clinical trial
030104 developmental biology
chronic lymphocytic leukemia
business
CLL
Zdroj: Cancer Medicine
Cancer Medicine, Vol 10, Iss 8, Pp 2690-2702 (2021)
ISSN: 2045-7634
DOI: 10.1002/cam4.3855
Popis: Background Information on overall survival (OS) and adverse events (AEs) in patients with chronic lymphocytic leukemia (CLL) is mostly available from clinical trials. We therefore conducted a population‐based retrospective cohort study to assess OS, incidence of AEs, and economic burden in real‐world practice among Medicare patients treated for CLL. Methods Patients with CLL receiving ≥1 systemic therapy from 2013 to 2015 were selected from the Medicare claims database and followed from the start of first observed systemic therapy (index date) through December 2016 or death. OS for patients receiving each of the most commonly observed treatments was estimated by the Kaplan–Meier method. AEs were assessed among patients receiving these treatments across all observed lines of therapy. All‐cause direct medical costs were assessed from the Medicare system perspective. Results Among 7,965 eligible patients across all observed therapy lines, ibrutinib monotherapy (Ibr; n = 2,708), chlorambucil monotherapy (Clb; n = 1,620), and bendamustine/rituximab (BR; n = 1,485) were the most common treatments. For first observed therapy, 24‐month OS estimates for Ibr, Clb, and BR recipients were 69% (95% CI = 68%–71%), 68% (95% CI = 65%–71%), and 79% (95% CI = 77%–81%) respectively. The most frequently recorded AEs in patients receiving these treatments in any observed line of therapy were neutropenia, hypertension, anemia, and infection. For all patients, the mean monthly all‐cause cost during the follow‐up period was $8,974 (SD = $11,562); cost increased by the number of AEs, from $5,144 (SD = $5,409) among those with 1–2 AEs to $10,077 (SD = $12,542) among those with ≥6 AEs. Conclusion Over two‐thirds of patients survived at least 2 years after starting their first observed therapy for CLL. Our findings highlight considerable susceptibility to AEs and unmet medical need in Medicare patients with CLL treated in routine practice. Medicare incurred substantial economic burden following initiation of systemic therapy, and patients with greater numbers of AEs accounted disproportionately for the high overall cost of CLL management.
A population‐based retrospective analysis was conducted to document treatment patterns, overall survival, adverse events, and economic burden in Medicare patients with chronic lymphocytic leukemia (CLL). Findings demonstrate that over two‐thirds of patients survived at least 2 years after the start of their first observed therapy during the study period and that greater number of adverse events were associated with higher economic burden of CLL.
Databáze: OpenAIRE
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