Economic burden during remission and after relapse among older patients with newly diagnosed acute myeloid leukemia without hematopoietic stem cell transplant: A retrospective study using the SEER-Medicare database.

Acute myeloid leukemia (AML) is associated with a substantial clinical and economic burden. This study characterized the magnitude of this burden following initial treatment with standard or less intensive therapies (hypomethylating agents [HMAs]) and throughout different treatment phases post-remission. The Surveillance, Epidemiology, and End Results (SEER) cancer registry (2007-2016) linked with Medicare beneficiary claims (2007-2015) was analyzed. Patients were ≥ 65 years old with AML who initiated chemotherapy or HMAs and achieved remission. Outcomes included baseline characteristics, treatment patterns, clinical outcomes, healthcare resource utilization (HRU), and costs (2019 United States dollar). Economic impacts were stratified by treatment phase (initial treatment, early post-remission, late post-remission, and post-relapse). Early and late post-remission were defined as treatment initiated ≤ 60 days and > 60 days following initial treatment, respectively. A subgroup analysis of patients receiving only HMAs as initial treatment was also conducted. Overall, 530 patients were included (mean age: 74.1 years; 53.6 % male). In the overall analysis, 68.1 % of patients received post-remission treatment; 31.9% had no post-remission treatment. Mean monthly per patient healthcare costs by treatment phase were $45,747 (initial treatment), $30,248 (early post-remission), $23,173 (late post-remission), and $37,736 (post-relapse), driven predominantly by inpatient visits. The HMA subgroup analysis comprised 71 patients (mean age: 78.8 years; 50.7 % male); mean monthly per patient healthcare costs were highest post-relapse. The economic burden of AML among older patients is substantial across all treatment phases. AML treatments that induce and prolong remission may reduce HRU and the economic burden of disease.

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Copyright © 2023. Published by Elsevier Ltd.

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Declaration of Competing Interest AMB has received grants or contracts from Acceleron Pharma, Agios, Alexion, Amgen, AstraZeneca, Bristol Myers Squibb, Gilead, GSK, Janssen, Keros Therapeutics, Novartis, Pfizer, Taiho, Takeda; consulting fees from Pfizer; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Bristol Myers Squibb; support for attending meetings and/or travel from Pfizer; has participated on a Data Safety Monitoring Board or Advisory Board from Acceleron Pharma, Agios, Alexion, Amgen, AstraZeneca, Bristol Myers Squibb, Gilead, GSK, Janssen, Keros Therapeutics, Novartis, Pfizer, Taiho, Takeda; and has received equipment, materials, drugs, medical writing, gifts or other services from Bristol Myers Squibb. DH and RC are employees of and own stock or stock options in Bristol Myers Squibb. Z-YZ is an employee of and has received consulting fees from Bristol Myers Squibb. MLZ is a former employee of Analysis Group which has received consulting fees from Bristol Myers Squibb and is an employee of Takeda Pharmaceuticals. AA is an employee of Analysis Group and has received consulting fees from Bristol Myers Squibb. ND is an employee of Analysis Group which has received consulting fees from Bristol Myers Squibb. AM is an employee of Bristol Myers Squibb.