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Burden of Infections Among Chronic Myeloid Leukemia Patients Receiving Dasatinib or Nilotinib: A Real-World Retrospective Healthcare Claims Study in the United States

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Abstract

Introduction

Tyrosine kinase inhibitors (TKI) have been demonstrated to prolong survival in patients with chronic myeloid leukemia (CML). However, TKIs may be associated with an increased risk of infections. This study compared healthcare resource utilization (HRU) and costs among patients with CML receiving dasatinib or nilotinib, with a focus on infection-related economic outcomes.

Methods

Two large administrative databases were used to identify adult patients newly diagnosed with CML who initiated dasatinib or nilotinib as first- (1L) or second-line (2L) therapy and were classified into the following 1L (dasatinib 1L/nilotinib 1L cohorts) or 2L (dasatinib 2L/nilotinib 2L) cohorts based on the initiated 1L/2L TKI therapy. Infection-related HRU and healthcare costs were compared between cohorts, separately for 1L and 2L.

Results

Cohorts included 1156 patients in the dasatinib 1L and 677 patients in the nilotinib 1L cohorts, 322 patients in the dasatinib 2L, and 207 in the nilotinib 2L cohorts. In 1L and 2L, infection-related HRU was higher for dasatinib than nilotinib cohorts. Infection-related inpatient (IP) days constituted a larger proportion of all-cause IP days in the 1L/2L dasatinib than 1L/2L nilotinib cohorts (dasatinib 1L/2L: 53%/58%; nilotinib 1L/2L: 50%/46%). Compared to the nilotinib cohort, the dasatinib cohort had higher all-cause total costs per patient per year by US$17,901 in 1L and $28,625 in 2L. Of the total cost difference, infection-related were $6048 (34%) in 1L and $28,192 (99%) in 2L, largely driven by IP cost differences (1L/2L: 96%/98%).

Conclusions

Dasatinib was associated with higher HRU and healthcare costs compared to nilotinib, particularly related to infections.

Funding

Novartis Pharmaceutical Corporation.

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Acknowledgements

Funding

Sponsorship for this study and article processing charges were funded by Novartis Pharmaceutical Corporation. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Medical Writing, Editorial, and Other Assistance

The authors thank Islam Sadek, an employee of Novartis, for review of the data and scientific input. Medical writing assistance was provided by Sara Kaffashian, an employee of Analysis Group Inc. Analysis Group received consulting fees from Novartis for the conduct of this study.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Karen Seiter has received consulting fees from Novartis as a consultant. Dominick Latremouille-Viau is an employee of Analysis Group, Inc., which has received consultancy fees from Novartis. Annie Guerin is an employee of Analysis Group, Inc., which has received consultancy fees from Novartis. Irina Pivneva is an employee of Analysis Group, Inc., which has received consultancy fees from Novartis. Patrick Gagnon-Sanschagrin is an employee of Analysis Group, Inc., which has received consultancy fees from Novartis. Briana Ndife is an employee of Novartis. Karen Habucky is an employee of Novartis and owns stocks in Novartis and J&J. Derek H. Tang is an employee of Novartis and owns stocks in Novartis. George J. Joseph is an employee of Novartis and owns stocks in Amgen, Pfizer, and Express Scripts.

Compliance with Ethics Guidelines

Data were de-identified to comply with the confidentiality requirements of the Health Insurance Portability and Accountability Act and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Therefore, no institutional review was required.

Data Availability

The claims databases used in this study are proprietary. The authors do not have permission to disseminate the data without the vendor’s approval. The study sponsor has purchased access to the databases and the authors have been granted access to the data on a contract per project use. Access to these datasets are available to any other interested parties for a fee set by the vendor.

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Authors and Affiliations

  1. New York Medical College, Valhalla, NY, USA

    Karen Seiter

  2. Analysis Group, Inc., Montreal, QC, Canada

    Dominick Latremouille-Viau, Annie Guerin, Irina Pivneva & Patrick Gagnon-Sanschagrin

  3. Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

    Briana Ndife, Karen Habucky, Derek H. Tang & George J. Joseph

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  1. Karen Seiter
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Correspondence to Irina Pivneva.

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Seiter, K., Latremouille-Viau, D., Guerin, A. et al. Burden of Infections Among Chronic Myeloid Leukemia Patients Receiving Dasatinib or Nilotinib: A Real-World Retrospective Healthcare Claims Study in the United States. Adv Ther 35, 1671–1685 (2018). https://doi.org/10.1007/s12325-018-0772-3

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