PMID- 37981560
OWN - NLM
STAT- MEDLINE
DCOM- 20240101
LR  - 20240416
IS  - 1879-114X (Electronic)
IS  - 0149-2918 (Linking)
VI  - 46
IP  - 1
DP  - 2024 Jan
TI  - Health Care Resource Utilization and Total Costs of Care for Adult Patients With 
      Relapsed or Refractory Acute Lymphoblastic Leukemia in the United States: A 
      Retrospective Claims Analysis.
PG  - 3-11
LID - S0149-2918(23)00428-9 [pii]
LID - 10.1016/j.clinthera.2023.10.020 [doi]
AB  - PURPOSE: Although immunotherapies such as blinatumomab and inotuzumab have led to 
      improved outcomes, financial burden and health resource utilization (HRU) have 
      increased for adult patients with relapsed or refractory B-cell acute 
      lymphoblastic leukemia (R/R B-ALL). This study assessed real-world HRU and costs 
      of care among adult patients with R/R B-ALL by line of therapy (LoT) in the 
      United States. METHODS: We selected patients from the MarketScan(Ⓡ) Database 
      (January 1, 2016 through December 31, 2020) as follows: >/=1 claims of 
      ALL-indicated first-line (1L) therapies, >/=1 diagnosis of ALL before the index 
      date (1L initiation date), 6-month continuous enrollment before the index date, 
      second-line (2L) therapy initiation, >/=18 years old at 2L, no clinical trial 
      enrollment, no diagnosis of other forms of non-Hodgkin's lymphoma, and no claim 
      for daratumumab or nelarabine during the study period. Outcome measures included 
      claim-based time to next treatment (TTNT), all-cause and adverse event 
      (AE)-related HRU, and all-cause and AE-related costs. FINDINGS: The R/R B-ALL 
      cohort (N = 203) was 60% male, median age of 41 years, and median Charlson 
      Comorbidity Index score of 3.0. Mean (SD) follow-up was 17.8 (11.8) months. Of 
      those who received 2L, 55.7% (113/203) required 3L, and 15% (30/203) initiated 
      4L+. Patients relapsed quickly, with a median TTNT of 170 days, 169 days, and 205 
      days for 2L, 3L, and 4L+, respectively. Hospitalization rates were high across 
      each LoT (2L, 88%; 3L, 73%; 4L+, 73%), and the mean (SD) inpatient length of stay 
      increased by LoT as follows: 8.6 (6.8) days for 2L, 10.6 (13.3) for 3L, and 11.6 
      (13.6) for 4L+. Mean (SD) overall costs were substantial within each LoT at 
      $513,279 ($599,209), $340,419 ($333,555), and $390,327 ($332,068) for 2L, 3L, and 
      4L+, respectively. The mean (SD) overall/per-patient-per-month AE-related costs 
      were $358,676 ($497,998) for 2L, $202,621 ($272,788) for 3L, and $210,539 
      ($267,814) for 4L+. Among those receiving blinatumomab or inotuzumab within each 
      LoT, the mean (SD) total costs were $566,373 ($621,179), $498,070 ($376,260), and 
      $512,908 ($159,525) for 2L, 3L, and 4L+, respectively. IMPLICATIONS: These 
      findings suggest that adult patients with R/R B-ALL relapse frequently with 
      standard of care and incur a substantial HRU and cost burden with each LoT. Those 
      treated with blinatumomab or inotuzumab incurred higher total costs within each 
      LoT compared with the overall R/R B-ALL cohort. Alternative therapies with longer 
      duration of remission are urgently needed, and HRU should be considered for 
      future studies examining the optimal sequencing of therapy.
CI  - Copyright (c) 2023 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Ito, Diane
AU  - Ito D
AD  - Stratevi, Santa Monica, California. Electronic address: diane@stratevi.com.
FAU - Feng, Chaoling
AU  - Feng C
AD  - Kite, a Gilead Company, Santa Monica, California.
FAU - Fu, Christine
AU  - Fu C
AD  - Kite, a Gilead Company, Santa Monica, California.
FAU - Kim, Chong
AU  - Kim C
AD  - Stratevi, Santa Monica, California.
FAU - Wu, James
AU  - Wu J
AD  - Kite, a Gilead Company, Santa Monica, California.
FAU - Dalton, David
AU  - Dalton D
AD  - Kite, a Gilead Company, Santa Monica, California.
FAU - Epstein, Josh
AU  - Epstein J
AD  - Stratevi, Santa Monica, California.
FAU - Snider, Julia T
AU  - Snider JT
AD  - Kite, a Gilead Company, Santa Monica, California.
FAU - DuVall, Adam S
AU  - DuVall AS
AD  - University of Chicago Medicine, Chicago, Illinois.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20231118
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
SB  - IM
MH  - Adult
MH  - Humans
MH  - Male
MH  - United States
MH  - Adolescent
MH  - Female
MH  - Retrospective Studies
MH  - *Insurance Claim Review
MH  - Patient Acceptance of Health Care
MH  - Hospitalization
MH  - *Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
MH  - Health Care Costs
OTO - NOTNLM
OT  - Adult acute lymphoblastic leukemia
OT  - Economic burden
OT  - Health care resource utilization
OT  - Relapsed or refractory
OT  - Total costs of care
OT  - Treatment patterns
COIS- Declaration of Competing Interest D. Ito, J. Epstein, and C. Kim (employee at the 
      time of the study) are employees of Stratevi, a consulting firm that received 
      research funding from Kite Pharma, a Gilead Company, to conduct this study. C. 
      Feng, C. Fu, J. Wu, and J.T. Snider are employees of Kite Pharma and in the 
      course of their employment have received stock options exercisable for, and other 
      stock awards of, ordinary shares of Gilead Sciences. A. DuVall is an unpaid 
      independent joint researcher to this study. The authors have indicated 
      that they have no other conflicts of interest with regard to the content of 
      this article.
EDAT- 2023/11/20 00:43
MHDA- 2024/01/02 11:42
CRDT- 2023/11/19 22:00
PHST- 2023/07/11 00:00 [received]
PHST- 2023/10/20 00:00 [revised]
PHST- 2023/10/25 00:00 [accepted]
PHST- 2024/01/02 11:42 [medline]
PHST- 2023/11/20 00:43 [pubmed]
PHST- 2023/11/19 22:00 [entrez]
AID - S0149-2918(23)00428-9 [pii]
AID - 10.1016/j.clinthera.2023.10.020 [doi]
PST - ppublish
SO  - Clin Ther. 2024 Jan;46(1):3-11. doi: 10.1016/j.clinthera.2023.10.020. Epub 2023 
      Nov 18.