Economic burden of treatment failure in chronic lymphocytic leukemia patients.

ABSTRACT

OBJECTIVE: This study assessed healthcare costs of first-line treatment failure (TF) in patients with chronic lymphocytic leukemia (CLL), a subtype of non-Hodgkin's lymphoma. METHODS: Pre-diagnosis treatment-naïve adults with ≥2 CLL diagnoses initiated on an antineoplastic agent (index date) after their first CLL diagnosis with ≥12 and ≥6 months of continuous observation pre- and post-index, respectively, were selected from the Truven Health MarketScan Research Databases. Patients had no solid malignancies in the pre-index period nor selected blood malignancies at any time. Initial therapy included antineoplastic agents initiated in the first 30 days post-index. TF occurred at the earliest of initiation of a new antineoplastic agent, treatment resumption following a ≥3 month break, non-chemotherapy intervention (stem cell transplant or radiotherapy), hospice care or hospital mortality. The cost of TF was evaluated as the healthcare cost difference between patients with and without first-line TF using ordinary least square regressions adjusted for baseline characteristics. Non-parametric bootstrap was used to evaluate statistical significance. RESULTS: Among 2226 patients identified (mean age 68 years; female 41%), 46% experienced first-line TF. The average TF cost was $3011 per patient per month (p < .001). When stratifying patients by event indicating TF and by most common therapies, non-chemotherapy intervention ($7582 per patient per month; p < .0001) and fludarabine/cyclophosphamide/rituximab ($4758; p < .001) were associated with the highest TF cost, respectively. CONCLUSIONS: The cost of first-line TF is high and varies across first-line therapies. This should be considered when selecting the initial therapy in these patients.