PMID- 32880204 OWN - NLM STAT- MEDLINE DCOM- 20210702 LR - 20240403 IS - 2376-1032 (Electronic) IS - 2376-0540 (Print) IS - 2376-0540 (Linking) VI - 26 IP - 10 DP - 2020 Oct TI - Time to Next Treatment, Health Care Resource Utilization, and Costs Associated with Ibrutinib Use Among U.S. Veterans with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Real-World Retrospective Analysis. PG - 1266-1275 LID - 10.18553/jmcp.2020.20095 [doi] AB - BACKGROUND: Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common adult leukemia, accounting for approximately 37% of all leukemias in the United States. Limited real-word evidence is available on the outcomes of ibrutinib use among previously untreated patients in the U.S. Veterans Health Administration (VHA) population diagnosed with CLL/SLL. OBJECTIVES: To (a) evaluate time to next treatment (TTNT) among U.S. veterans with CLL/SLL who initiated ibrutinib versus chemoimmunotherapy (CIT) in first line (1L) and 1L ibrutinib versus ibrutinib in later lines (2L+) and (b) compare health care resource utilization (HRU) and costs between the 1L ibrutinib and CIT cohorts. METHODS: Adults with CLL/SLL and claims for 1L single-agent ibrutinib or CIT (index date = first prescription claim date) were included from Veterans Health Administration Data (April 1, 2013-March 31, 2018). A subset of the CIT 1L cohort with evidence of ibrutinib in 2L/3L was defined as the ibrutinib 2L+ cohort. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate TTNT, and generalized linear models were used to determine all-cause per patient per month (PPPM) HRU and costs during 1L among propensity score-matched (PSM) cohorts. RESULTS: After PSM, 614 patients were included in each of the 1L ibrutinib and 1L CIT cohorts, and 149 were included in each of the 1L ibrutinib and 2L+ ibrutinib cohorts. The 1L ibrutinib cohort had significantly longer TTNT compared with each of the 1L CIT and 2L+ ibrutinib cohorts (P <0.0001 and P =0.0001, respectively) and was less likely to have a next line of treatment than the CIT 1L cohort (HR = 0.52; 95% CI = 0.42-0.65; P < 0.0001) and the 2L+ ibrutinib cohort (HR = 0.39; 95% CI = 0.22-0.69; P = 0.0012). The 1L ibrutinib cohort had significantly fewer inpatient visits (rate ratio [RR] = 0.38; 95% CI = 0.28-0.52; P 0.05). CONCLUSIONS: These findings demonstrate that among U.S. veterans with CLL/SLL, 1L ibrutinib use was associated with significantly longer TTNT versus that of 1L CIT. Similarly, early treatment with ibrutinib was associated with longer TTNT as compared to ibrutinib use in later lines of therapy. Moreover, 1L ibrutinib was associated with lower HRU and medical costs compared with 1L CIT, completely offsetting the higher pharmacy costs related to 1L ibrutinib treatment. DISCLOSURES: This research was sponsored by Janssen Scientific Affairs. The analyses were performed by STATinMED Research. Huang is an employee of Janssen Scientific Affairs and may own company stock. Sundaram was an employee of Janssen Scientific Affairs at the time this study was conducted. Borra and Janjan are employees of STATinMED Research, a paid consultant to the study sponsor. Wang, Li, and Shrestha were employees of STATinMED Research at the time this study was conducted. FAU - Huang, Qing AU - Huang Q AD - Janssen Scientific Affairs, Horsham, Pennsylvania. FAU - Borra, Sujana AU - Borra S AD - STATinMED Research, Plano, Texas. FAU - Li, Jieni AU - Li J AD - STATinMED Research, Plano, Texas. FAU - Wang, Li AU - Wang L AD - STATinMED Research, Plano, Texas. FAU - Shrestha, Sulena AU - Shrestha S AD - STATinMED Research, Plano, Texas. FAU - Sundaram, Murali AU - Sundaram M AD - Janssen Scientific Affairs, Horsham, Pennsylvania. FAU - Janjan, Nora AU - Janjan N AD - STATinMED Research, Plano, Texas. LA - eng PT - Comparative Study PT - Journal Article DEP - 20200903 PL - United States TA - J Manag Care Spec Pharm JT - Journal of managed care & specialty pharmacy JID - 101644425 RN - 0 (Antineoplastic Agents) RN - 0 (Piperidines) RN - 0 (Protein Kinase Inhibitors) RN - 1X70OSD4VX (ibrutinib) RN - JAC85A2161 (Adenine) SB - IM MH - Adenine/administration & dosage/*analogs & derivatives/economics MH - Aged MH - Aged, 80 and over MH - Antineoplastic Agents/administration & dosage/economics MH - Cohort Studies MH - Drug Costs/statistics & numerical data MH - Female MH - Health Care Costs/*statistics & numerical data MH - Humans MH - Immunotherapy/economics/methods MH - Leukemia, Lymphocytic, Chronic, B-Cell/*drug therapy/economics MH - Male MH - Middle Aged MH - Patient Acceptance of Health Care/statistics & numerical data MH - Piperidines/*administration & dosage/economics MH - Protein Kinase Inhibitors/*administration & dosage/economics MH - Retrospective Studies MH - Time Factors MH - United States MH - Veterans PMC - PMC10391290 COIS- This research was sponsored by Janssen Scientific Affairs. The analyses were performed by STATinMED Research. Huang is an employee of Janssen Scientific Affairs and may own company stock. Sundaram was an employee of Janssen Scientific Affairs at the time this study was conducted. Borra and Janjan are employees of STATinMED Research, a paid consultant to the study sponsor. Wang, Li, and Shrestha were employees of STATinMED Research at the time this study was conducted. EDAT- 2020/09/04 06:00 MHDA- 2021/07/03 06:00 PMCR- 2020/10/01 CRDT- 2020/09/04 06:00 PHST- 2020/09/04 06:00 [pubmed] PHST- 2021/07/03 06:00 [medline] PHST- 2020/09/04 06:00 [entrez] PHST- 2020/10/01 00:00 [pmc-release] AID - 10.18553/jmcp.2020.20095 [doi] PST - ppublish SO - J Manag Care Spec Pharm. 2020 Oct;26(10):1266-1275. doi: 10.18553/jmcp.2020.20095. Epub 2020 Sep 3.