HCRU and Costs Among Medicare Beneficiaries With Myelofibrosis Receiving Ruxolitinib

A group of researchers recently evaluated health care resource utilization (HCRU), direct costs, and overall survival (OS) for Medicare beneficiaries with myelofibrosis (MF) who receive ruxolitinib treatment (J Med Econ. 2023 June 30;26[1]:843-849. doi:10.1080/13696998.2023.2224017).

Aaron T. Gerds, MD, Cleveland Clinic Taussif Cancer Institute, Cleveland, Ohio, and colleagues utilized the US Medicare fee-for-service database (parts A/B/D) to obtain data on patients with MF who were diagnosed between January 1, 2012, and December 31, 2017. They also used the Kaplan-Meier analysis to estimate the OS of the patients.

To be eligible for the study, the participants needed to be ≥65 years old and have continuous medical and pharmacy enrollment for a minimum of 12 months prior to the date they were diagnosed with MF (the index date). If the patients had received allogeneic hematopoietic cell transplantation, or if they had been diagnosed with MF before the preindex period, they were excluded from the study. The participants (a total of 10,049 patients) were divided into two groups: those who filled ≥1 prescription of ruxolitinib (2,787) and those who did not fill the prescription during the variable follow-up period (7,262).

The study found that the patient cohort with the ruxolitinib prescription had lower mean (95% confidence interval [CI]) rates (per patient per month [PPPM]) for HCRU compared to the other cohort. The rates of hospitalizations for the prescription cohort were 0.16 vs 0.32 for those who did not have a prescription. For length of inpatient stay and emergency department visits, the rates were 0.16 vs 2.44 days and 0.10 vs 0.14, respectively (95% CI).

For resources outside of hospitals, the mean (95% CI) rates were the following for patients who had a ruxolitinib prescription vs those who did not: 4.68 vs 6.25 for physician office visits, 0.02 vs 0.12 for stays at skilled nursing facilities, 0.32 vs 0.47 for home health/durable medical equipment services, and 0.30 vs 1.70 for hospice visits, respectively.

In terms of direct costs, monthly medical costs were $6,553 for patients who filled the prescription vs $12,929 for those who did not. However, pharmacy costs were greater for the ruxolitinib cohort ($10,065) compared to the other patient cohort ($987). The total PPPM all-cause health care cost for the first group was $16,618 while the nonprescription group had a cost of $13,916. In addition to lower HCRU and direct costs, the patients who filled ruxolitinib prescriptions had a higher median OS of 37.5 months compared to 18.7 months for the patients who did not (hazard ratio, 0.63; 95% CI, 0.59-0.67).

The authors acknowledge that the study had several limitations. For instance, only patients with Medicare benefits were included, which does not account for those who may not have insurance or do not have equal access to health care resources. Also, the study did not investigate specific doses or treatment durations for the ruxolitinib therapy.

Overall, the researchers found that monthly HCRU and direct medical costs were significantly lower for the study participants who filled ≥1 prescription of ruxolitinib vs those who did not. These savings also greatly compensate for the higher pharmacy costs in the ruxolitinib cohort. In addition, the patients who filled the ruxolitinib prescription experienced longer OS.

“These results support the claim that ruxolitinib is a cost-effective treatment for patients with MF in a real-world setting,” said Dr Gerds and colleagues.

The authors suggest that follow-up studies should include quality-adjusted life units and work productivity in order to explore how these factors may impact these patients’ quality of life and the indirect costs of MF treatment.