Program: Oral and Poster Abstracts
Session: 902. Health Services and Outcomes Research – Malignant Diseases: Poster III
Methods: A retrospective observational study was conducted using the IMS Health PharMetrics Plus Health Plan Claims Database for the period 2006-2014. The database includes over 150 million unique health plan members across the US and is nationally representative of the commercially-insured US population. Database includes medical and outpatient pharmacy claims for individuals enrolled in managed care health plans. Information on charged and paid amounts along with co-pay information is included in claim records. Additionally, claim records include details on, but not limited to, diagnoses, procedures, date of service, and discharge date (inpatient visit). Adult (≥18 years of age) patients with at least two claims with a diagnosis of HCL (ICD-9-CM code: 202.4x) were selected and the first observed claim defined the “index date.” Patients with evidence of other malignancies (identified using relevant ICD-9-CM codes) during the 6-month prior (pre-index period) to the index date were excluded. Patients were required to have at least 90 days of continuous enrollment (the variable “follow-up” period) in the health plan post index date with exception of patients who died within 3 months of diagnosis. Patients were followed until death (recorded on inpatient discharge disposition) or until the end of database. Study measures including baseline costs (pre-index period) and follow-up period all-cause and HCL-related (assessed based on presence of HCL diagnosis code and/or HCL-associated therapies) utilization and costs were evaluated on a per-patient basis. Annualized healthcare utilization and costs were also estimated [(annualized rate of use/costs = (units used or costs post-index)/(days follow-up post-index/365)]. All analyses were descriptive in nature with continuous measures (e.g., HCL-related inpatient costs) measures presented using mean, median, standard deviation (SD) and categorical measures (e.g., patient with a HCL-related inpatient admission) using frequency and percentages. Cost analyses were conducted from a payer perspective (i.e., paid amounts [not charged amounts] were used in cost estimation).
Results: The study cohort included 749 patients with mean (SD) post-diagnosis follow-up of 32 (22) months. Over 3/4th of patients were males (77%) and the mean age (SD) at diagnosis was 56 (10) years. The mean pre-index per patient costs for the study cohort was $5,858 ($13,836). Slightly more than a third (38%) of patients initiated first-line chemotherapy over the available follow-up, and pre-index costs were higher among patients initiating chemotherapy compared with to those who did not initiate chemotherapy ($6,635 [$7,246] vs. $5,389 [$16,584]). 36% of patients had at least 1 HCL-related inpatient admission and over 95% had at least 1 HCL-related physician office visit during the follow-up period. The average follow-up period all-cause costs were $55,904 of which 50% were related to outpatient care, 40% related to inpatient care and 9% related to outpatient pharmacy costs. The mean annualized all-cause costs were $50,585 of which over 65% (mean: $33,111) attributed to inpatient costs. The follow-up period HCL-related total costs were $31,234 of which HCL-related inpatient costs accounted for 55% and 44% were attributed to HCL-related outpatient care. The mean annualized HCL-related costs were $38,588 with the vast majority (81%) attributed to inpatient costs.
Conclusion: The current study provides real-world all-cause and HCL costs estimates from a payer perspective among patients with HCL. With newer therapies being developed for HCL, findings from this study can serve as inputs in the development of cost-effectiveness models comparing new and existing treatments.
Disclosures: Divino: IMS Health: Employment , Other: IMS Health received funding from AstraZeneca for this study . Karve: AstraZeneca: Employment . Gaughan: AstraZeneca: Employment . DeKoven: IMS Health: Employment , Other: IMS Health received funding from AstraZeneca for this study . Gao: MedImmune: Employment . Lanasa: MedImmune: Employment .
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