Real-World Health Care Resource Use and Costs Among Patients With Chronic Lymphocytic Leukemia Treated With Venetoclax-Based and Bruton Tyrosine Kinase Inhibitor-Based Regimens in the Second-Line Setting.

PURPOSE: Real-world evidence comparing health care resource use (HRU) and costs between novel targeted therapies among patients with chronic lymphocytic leukemia (CLL) is lacking. We compared all-cause and CLL-specific HRU and costs between patients initiated on B-cell lymphoma 2 inhibitor (venetoclax)- or Bruton tyrosine kinase inhibitor (BTKi)-based regimens in the second-line (2L) setting. METHODS: This is a retrospective observational study using Optum Clinformatics Data Mart of adult patients with CLL/small lymphocytic lymphoma who received 2L venetoclax- or BTKi-based regimens (January 2018-December 2021) for the first time and had ≥one CLL diagnostic claim after 2L initiation and ≥two claims for venetoclax or BTKi. Baseline characteristics were balanced using stabilized inverse probability of treatment weights. Mean monthly cost difference (MMCD) between cohorts for all-cause and CLL-specific per patient per month (PPPM) costs was estimated. Rates of PPPM-HRU were compared between cohorts using rate ratios (RRs). RESULTS: Of 280 patients, median age 75.5 years, 64.6% and 35.4% received BTKi- versus venetoclax-based regimens, respectively. Most BTKi-treated patients received monotherapy (88.4%), whereas 62.3% of venetoclax-treated patients received combination therapy with anti-CD20 agents. The median duration of 2L therapy was 11.6 and 11.0 months for BTKi versus venetoclax cohorts, respectively. All-cause total costs were lower for venetoclax versus BTKi (MMCD [SE], $-2,497.64 [$1,006.77] in US dollars (USD); P = .01), driven by lower medication costs offsetting medical costs; trends were similar for CLL-specific estimates. Outpatient HRU was higher for venetoclax versus BTKi (RR all-cause: 1.22 versus CLL-specific: 1.64). CONCLUSION: Venetoclax was associated with total monthly cost savings versus BTKis, illustrating the economic value of time-limited venetoclax-based regimens in the 2L setting.

Passive social health surveillance and inpatient readmissions.

OBJECTIVES: To determine whether self-identified social needs, such as financial assistance with utilities, food programs, housing support, transportation, and medication assistance, collected using a passive social health surveillance system were associated with inpatient readmissions. STUDY DESIGN: Cross-sectional, retrospective observational study. METHODS: This retrospective observational study linked social service referral data collected from a call center-based passive social health surveillance system with healthcare claims data extracted from a managed care organization (MCO). Mixed-effects logistic regression models calculated the odds of all-cause hospital readmissions within 30, 90, and 180 days among individuals with self-identified social service needs compared with those without. RESULTS: Individuals who identified social service needs had 68% (odds ratio [OR], 1.68; 95% CI, 1.51-1.86), 89% (OR, 1.89; 95% CI, 1.74-2.05), and 101% (OR, 2.01; 95% CI, 1.87-2.17) higher odds of readmission within 30, 90, and 180 days, respectively, after controlling for other study variables. Examining each social service need separately, individuals had higher odds of hospital readmission within 30 days of discharge if they identified a financial (OR, 1.19; 95% CI, 1.07-1.33), food (OR, 1.32; 95% CI, 1.17-1.48), housing (OR, 1.31; 95% CI, 1.09-1.57), or transportation (OR, 1.21; 95% CI, 1.08-1.36) need compared with those without those social needs. In all study outcomes, medication assistance was not associated with readmissions. CONCLUSIONS: An MCO created a passive social health surveillance program to more effectively integrate medical and social care. Understanding individual-level social health needs provides the insights needed to develop interventions to prevent hospital readmissions.

Expenditure Reductions Associated with a Social Service Referral Program.

Recent health system innovations provide encouraging evidence that greater coordination of medical and social services can improve health outcomes and reduce health care expenditures. This study evaluated the savings associated with a managed care organization's call center-based social service referral program that aimed to assist participants address their social needs, such as homelessness, transportation barriers, and food insecurity. The program evaluation linked social service referral data with health care claims to analyze expenditures in 2 annual periods, before and after the first social service referral. Secondary data analysis estimated the change in mean expenditures over 2 annual periods using generalized estimating equations regression analysis with the identity link. The study compared the change in mean health care expenditures for the second year for those reporting social needs met versus the group whose needs remained unmet. By comparing the difference between the first and second year mean expenditures for both groups, the study estimated the associated savings of social services, after controlling for group differences. These results showed that the decrease in second year mean expenditures for the group of participants who reported all of their social needs met was $2443 (10%) greater than the decrease in second year mean expenditures for the group who reported none of their social needs met, after controlling for group differences. Organizations that integrate medical and social services may thrive under policy initiatives that require financial accountability for the total well-being of patients.