Tyrosine Kinase Inhibitors and the Relationship With Adherence, Costs, and Health Care Utilization in Commercially Insured Patients With Newly Diagnosed Chronic Myeloid Leukemia: A Retrospective Claims-Based Study.
Adolescent
Adult
Antineoplastic Agents
/ economics
Dasatinib
/ economics
Female
Health Care Costs
Humans
Imatinib Mesylate
/ economics
Insurance Claim Review
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
/ drug therapy
Male
Medication Adherence
/ statistics & numerical data
Middle Aged
Patient Acceptance of Health Care
/ statistics & numerical data
Protein Kinase Inhibitors
/ economics
Pyrimidines
/ economics
Retrospective Studies
Young Adult
Journal
American journal of clinical oncology
ISSN: 1537-453X
Titre abrégé: Am J Clin Oncol
Pays: United States
ID NLM: 8207754
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
pubmed:
19
4
2020
medline:
24
10
2020
entrez:
19
4
2020
Statut:
ppublish
Résumé
To examine the association among tyrosine kinase inhibitor (TKI) out-of-pocket costs, adherence, and health care costs and utilization in a large group of commercially insured patients with chronic myeloid leukemia (CML). Patients with CML aged 18 to 64 years were identified using IBM MarketScan Commercial Database between April 1, 2011 and December 31, 2014. Patients were required to be continuously enrolled 3 months before and 12 months after TKI (imatinib, dasatinib, or nilotinib) initiation. TKI adherence is estimated using the proportion of days covered (PDC), defined as the percentage of the PDC by the prescription fill during the 12-month study period (adherent patients have PDC ≥80%). Health care cost differences between adherent and nonadherent patients were estimated using generalized linear models. Health care utilization was compared using negative binomial regression models. All models were controlled for potential confounding factors. The study sample consisted of 863 patients, where 355 (41.1%) patients were classified as adherent. Over the study period, nonadherent patients incurred US$10,974 more in medical costs (P<0.001), and US$1663 more in non-TKI pharmacy costs (P<0.01). Adherent patients incurred US$28,184 more in TKI pharmacy costs (P<0.001) that resulted in US$18,305 more in overall total health care costs (P<0.001). Adherent patients, however, were estimated to be less likely to have all-cause hospitalizations (incidence rate ratio, 0.32; P<0.001), or CML-specific hospitalizations (incidence rate ratio, 0.31; P<0.01). Patients with CML with better adherence experienced fewer hospitalizations, resulting in medical service cost savings. These lower medical costs, however, were more than offset by higher TKI medication costs observed during the first year of TKI therapy.
Identifiants
pubmed: 32304434
doi: 10.1097/COC.0000000000000700
pii: 00000421-202007000-00010
doi:
Substances chimiques
Antineoplastic Agents
0
Protein Kinase Inhibitors
0
Pyrimidines
0
Imatinib Mesylate
8A1O1M485B
nilotinib
F41401512X
Dasatinib
RBZ1571X5H
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
517-525Références
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