Economic Burden of Systemic Therapy Among Medicare Patients With CLL

Study findings highlight substantial economic burden incurred by Medicare among patients with chronic lymphocytic leukemia (CLL) who initiated systemic therapy in routine practice, citing adverse events (AEs) as a large contributor to the high overall cost of CLL management (Cancer Med. 2021;10[8]:2690-2702. doi:10.1002/cam4.3855. Epub 2021 Mar 18.).

“Information on overall survival (OS) and AEs in patients with CLL is mostly available from clinical trials,” wrote Ravi K Goyal, RTI Health Solutions, Research Triangle Park, NC, and colleagues.

Therefore, in this study, they aimed to assess OS, incidence of AEs, and economic burden in real-world practice among Medicare patients treated for CLL. 

The Medicare claims database was used to identify patients with CLL receiving at least 1 systemic therapy from 2013-2015. Patients were observed from the start of first observed systemic therapy through December 2016 or death.

The Kaplan-Meier method was used to calculate OS for patients receiving each of the most commonly observed treatments. Patients who received these treatments across all observed lines of therapy were assessed for AEs. All-cause direct medical costs were assessed from the Medicare system perspective.

The most common treatments were ibrutinib monotherapy (n = 2708), chlorambucil monotherapy (n = 1620), and bendamustine/rituximab (n = 1485). OS estimates for the first 24 months after patients received ibrutinib were 69%, while chlorambucil estimates were 68%, and bendamustine/rituximab estimates were 79%. Neutropenia, hypertension, anemia, and infection were the most frequent AEs among patients in this study.

The mean cost during the 24-month follow-up period was $8974. Cost increased from $5144 among patients with 1-2 AEs to $10,077 among patients with 6 or more AEs.

More than two-thirds of patients in this study survived 2 or more years after their first therapy for CLL.

“Our findings highlight considerable susceptibility to AEs and unmet medical need in Medicare patients with CLL treated in routine practice” wrote Dr Goyal and colleagues, concluding, “Medicare incurred substantial economic burden following initiation of systemic therapy, and patients with greater numbers of AEs accounted disproportionately for the high overall cost of CLL management.”—Marta Rybczynski