Costs and Healthcare Utilization with Myeloproliferative Neoplasms

Atlanta—A retrospective cohort analysis found that total healthcare costs for Medicare patients with myeloproliferative neoplasms (MPNs) were 1.5 to 3 times higher and hospitalizations were significantly higher compared with a matched control group.

Results were presented during a poster session at the ASH meeting. The poster was titled Healthcare Utilization and Associated Costs in Persons with Non-CML Myeloproliferative Neoplasms: Real World Evidence from a United States Medicare Population.

Although MPNs are rare, with an incidence from 0.5 to 3 per 100,000 persons depending on subtype, they lead to an increased risk of complications such as venous thromboembolism, myocardial infarction, stroke, and infections and reduced survival. The authors noted examples of non-chronic myeloid leukemia MPNs are essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF).

Except for hematopoietic stem cell transplantation, none of the available treatment options cure MPNs, and the therapies are expensive.

In this study, the authors analyzed the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database that included clinical information from the SEER cancer registry and medical and pharmacy claims for Medicare enrollees. Patients were included if they had a new MPN diagnosis between January 1, 2001, and December 31, 2007, no record of death before the end of the 1-year follow-up, were not enrolled in a health maintenance organization or discontinued Medicare coverage during the 1-year follow-up, and were not diagnosed with a non-MPN malignancy before the end of the 1-year follow-up. Patients who were enrolled in Medicare due to end stage renal disease were excluded.

The study enrolled 1355 MPN patients and assigned them matching controls: 445 had ET, 684 had PV, 81 had MF, and 145 had an unspecified MPN.

During the 1-year follow-up period, a significantly higher proportion of patients with MPN (26.6%) had ≥1 hospitalizations compared with the matching controls (15.4%) regardless of subtype (P<.05). In addition, the mean total days of hospital care (3.0) was higher in MPN patients compared with the controls (1.6), although the difference was not statistically significant for patients with PV (2.55 days vs 1.70 days for the matching controls).

During the 1-year follow-up period, the mean per patient all-cause cost was $11,259 for patients with ET compared with $8897 for controls; $13,337 for patients with PV compared with $8530 for controls; $20,917 for patients with MF compared with $7367 for controls; and $20,174 for patients with unspecified MPN compared with $9800 for controls. All comparisons were statistically significant (P<.05).

The authors mentioned several limitations. Although the 1-year follow-up period was required and helped align the risk exposure between patients with MPN and their controls, it may have also underestimated the total cost and shifted the distribution of MF cases to slightly younger patients because older patients may be less likely to survive during the follow-up period.

In addition, because the study only included Medicare patients, the results may not be generalizable to other groups, according to the authors. Further, the authors did not account for out-of-pocket costs, copayments, or indirect costs such as burdens to the caregivers. The authors said more studies should be conducted to evaluate costs during a longer follow-up period to better assess lifetime cost burdens.

This study was supported by Eli Lilly and Company.