Most patients with chronic lymphocytic leukemia (CLL) in the United States are treated in the frontline with either ibrutinib (ibr) or chemotherapy-backbone regimens (chemo), including chemoimmunotherapy (CIT). While treatment selection is based on risk stratification, comorbidities, patient choice, and physician preference, the comprehensive economic impact of selecting ibr versus chemo/CIT is not well-studied and is generally unknown. Thus, at ASH 2017, the authors presented the results of a study comparing the real-world healthcare resource utilization (HRU) of patients with CLL treated with ibr versus chemo/CIT in the first-line setting.1
Patients newly diagnosed with CLL were selected from the Inovalon Medical Outcomes Research for Effectiveness and Economics (MORE²) Registry payer claims and remittance data set. Patients receiving ibr or chemo/CIT regimens for CLL were compared across HRU from the start of their first cycle of therapy to the end of their first cycle of therapy. HRU was reported as per-patient per-month to mitigate the effects of different follow-up times. HRU was reported as inpatient, emergency department (ED), office visit (physician office), or other outpatient ambulatory visits (outpatient). Time to initiation was assessed from CLL diagnosis to the start of the patients’ first cycle of therapy. A total of 1086 patients were identified (178 [16.4%] on ibr and 908 [83.6%] on chemo/CIT). The top 5 chemo drugs used and dispensed were rituximab, bendamustine, cyclophosphamide, fludarabine, and vincristine, either alone or in combinations. Ibr-treated patients were more likely to have commercial insurance, while chemo/CIT patients were more likely to have Medicaid (41.6% vs 34.2% and 15.3% vs 9.6%, respectively; P = .046).
Mean costs per inpatient hospital stay per month were higher in the chemo/CIT patients versus with ibr ($1981 vs $1480; P = .004). Although there was no statistical difference in ED visits between the cohorts, costs of ED visits per month were higher in the chemo/CIT patients ($317 vs $152; P = .0002). Office visits per month were more frequent in chemo/CIT patients (5.7 vs 1.8; P <.0001), and mean costs per month were higher with chemo/CIT ($1365 vs $744; P <.0001). More frequent outpatient visits per month were observed in chemo/CIT patients versus ibr-treated patients (mean, 7.7 vs 3.6; P <.0001), translating to higher mean costs ($3613 vs $2326; P = .014).
The authors concluded that when used in first-cycle therapy for CLL, rates of resource utilization and total costs of care were significantly lower for ibr compared with chemo/CIT. Ibr-treated patients had lower ED and inpatient costs per month and less frequent office and outpatient visits than chemo/CIT-treated patients. Longer follow-up is needed to better understand the economic impact on patient outcomes.
Nabhan C, et al. ASH 2017. Abstract 2111.