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Real-World Treatment Patterns, Adverse Events, Resource Use, and Costs Among Commercially Insured, Younger Patients with Chronic Lymphocytic Leukemia in the USA: A Retrospective Cohort Study

A Correction to this article was published on 13 June 2020

This article has been updated

Abstract

Introduction

Amidst a changing treatment landscape, real-world evidence on the burden of chronic lymphocytic leukemia (CLL) is limited. The purpose of this study was to describe treatment patterns, adverse events (AEs), and economic burden among treated patients with CLL.

Methods

A retrospective cohort study was conducted with IQVIA PharMetrics® Plus. Patients at least 18 years old with CLL treatment between November 1, 2013 and May 31, 2018 were identified; index date was first observed CLL treatment. Patients had at least one CLL diagnosis pre-index and a second diagnosis anytime during the study period, at least 1-year pre- and at least 30-day post-index continuous enrollment and no pre-index CLL treatment. Analyses focused on patients receiving one of the four most common regimens observed. Outcomes included treatment patterns, frequency of incident AEs, and healthcare resource use and costs. Multivariable logistic regression and generalized linear modelling were used to evaluate risk of hospitalization and all-cause costs per patient per month (PPPM).

Results

A total of 1706 patients were included in the study (median [interquartile range] age 58 [55–62] years, 66% male, median Charlson Comorbidity Index 2 [2–3], median follow-up 16 [8–28] months). Common regimens, irrespective of treatment line, were bendamustine–rituximab (B-R, 27%), ibrutinib monotherapy (I, 27%), rituximab monotherapy (R, 19%), and fludarabine combined with cyclophosphamide and rituximab (FCR, 16%); 59% had at least one incident AE (B-R, 62%; I, 60%; R, 25%; FCR, 79%). Mean total all-cause healthcare cost over follow-up was $13,858 ± 14,626 PPPM. Increased number of AEs was associated with increased odds of hospitalization (odds ratio = 2.9; 95% confidence interval [CI] 2.5–3.4) and increased mean cost PPPM (cost ratio = 1.2; 95% CI 1.1–1.2).

Conclusion

This study highlights the treatment toxicity and associated economic burden among patients with CLL in the USA. As novel therapies are increasingly used, further research examining outcomes will inform the risks, benefits, and value of novel agents to prescribers and patients.

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Change history

  • 13 June 2020

    In the original article, it has been noticed that the abbreviation ‘‘CLL’’ is incorrectly published throughout the paper as the abbreviation “CCL”. The correct abbreviation is “CLL”.

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Acknowledgements

Funding

Sponsorship for this study and the journal's Rapid Service Fee were funded by AstraZeneca.

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

Shaum Kabadi is an employee of AstraZeneca. Aimee Near and Keiko Wada are employees of IQVIA, which received funding from AstraZeneca to conduct this research study. Chakkarin Burudpakdee was an employee of IQVIA at the time of the analysis and manuscript preparation.

Compliance with Ethics Guidelines

This study was based on secondary, de-identified data which comply with the Health Insurance Portability and Accountability Act (HIPAA). Institutional review board approval was not required for this study.

Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request. The data will not be deposited.

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Correspondence to Keiko Wada.

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Kabadi, S.M., Near, A., Wada, K. et al. Real-World Treatment Patterns, Adverse Events, Resource Use, and Costs Among Commercially Insured, Younger Patients with Chronic Lymphocytic Leukemia in the USA: A Retrospective Cohort Study. Adv Ther 37, 3129–3148 (2020). https://doi.org/10.1007/s12325-020-01350-w

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Keywords

  • Adverse events
  • Chronic lymphocytic leukemia
  • Costs
  • Healthcare resource use
  • Real world
  • Treatment patterns