CML-311: Healthcare Resource Utilization and Associated Costs Among Patients with Chronic Myeloid Leukemia by Line of Therapy in the United States (US) from a Commercial Perspective

Background: Despite advances in therapy, many patients with chronic myeloid leukemia in chronic phase (CML-CP) are refractory or intolerant to tyrosine kinase inhibitors (TKIs). Objective: To assess treatment patterns and economic outcomes among commercially insured patients with CML by line of TKI therapy (LOT). Methods: Adult patients with CML in the US who received ≥1 LOT were identified in the IBM MarketScan Commercial and Medicare Supplement databases (01/01/2001–06/30/2019). Treatment patterns, and all-cause and CML-related healthcare resource utilization (HRU: inpatient [IP] days, days with outpatient [OP] visits, and emergency department [ED] visits) and healthcare costs (medical+pharmacy) were measured by LOT; sensitivity analysis was performed after generic imatinib availability (02/01/2016). HRU was reported using annual incidence rates (IR), and costs (2019 USD, payer’s perspective) were reported per-patient-per-month (PPPM). Costs were stratified for hematopoietic stem cell transplantation (HSCT) status during LOT. Results: From 2001 to 2019, first-generation (1G) TKI (i.e., imatinib) was most prevalent in first-line (1L [N=3,234]; 66.2%), and second-generation (2G) TKIs (i.e., nilotinib, dasatinib, bosutinib) were most prevalent in second-line (2L [N=954]; 83.9%), third-line (3L [N=296]; 74.7%), and fourth-line (4L [N=83]; 69.9%). After 02/01/2016, 2G TKIs were most prevalent in 1L ([N=440]; 57.7%), 2L ([N=208]; 72.6%), 3L ([N=90]; 77.8%), and 4L ([N=29]; 69.0%). Annual IR increased between 1L and 4L: 1.3 to 2.4 for IP days, 23.1 to 31.6 for OP visits, and 0.6 to 0.8 for ED visits. The proportion of CML-related IP days increased from 69% to 80% between 1L and 4L. Mean all-cause costs increased between 1L and 4L from $10,340 (25% from medical) to $19,546 PPPM (47% from medical), with approximately 90% of costs CML-related. Excluding HSCT, mean all-cause costs increased from $10,322 (25% from medical) to $15,073 PPPM (31% from medical). After 02/01/2016, all-cause costs increased between 1L and 4L from $13,312 (21% from medical) to $18,379 PPPM (36% from medical). Excluding HSCT, mean all-cause costs increased from $13,275 (21% from medical) to $18,092 PPPM (35% from medical). Conclusions: Commercially insured patients with CML had increasing HRU and costs as they cycled through TKIs, highlighting the need for new treatments that can help optimize disease management. Sponsorship: Novartis