Analysis Group, Inc., Boston, Massachusetts, USA.
Curr Med Res Opin. 2010 Dec;26(12):2861-9. doi: 10.1185/03007995.2010.533648. Epub 2010 Nov 9.
To compare healthcare resource utilization, costs, and treatment adherence associated with dasatinib versus nilotinib treatment as second-line therapies in chronic myeloid leukemia (CML) patients.
Two large retrospective claims databases (01/1999-06/2009) were combined to identify CML patients (ICD-9 code 205.1x) who received one or more prescriptions of dasatinib or nilotinib. Studied patients had continuous enrollment ≥ 1 month prior to and after the index date, defined as the first prescription for dasatinib or nilotinib. Patients were followed for up to 6 months from the index date to the earliest of the termination of healthcare plan enrollment or end of data availability. Patients with bone marrow or stem cell transplant during the study period were excluded. Poisson regression models were used to compare healthcare resource utilization between the two groups. Results were reported as incidence rate ratios (IRR). Healthcare cost differences were estimated for each cost component using generalized linear models or two-part models. Treatment adherence was measured by the proportion of days covered (PDC) and compared using generalized linear models. Multivariate regressions were used to control for potential confounding factors.
A total of 521 CML patients receiving second-line tyrosine kinase inhibitors (TKI) (452 dasatinib and 69 nilotinib) were studied. During the study period, dasatinib patients were estimated to have more than twice as many inpatient days (IRR = 2.44; p < 0.001) and nearly double the number of inpatient admissions (IRR = 1.99; p = 0.047) compared to nilotinib patients. Over the follow-up period, dasatinib patients incurred $8828 more in total medical service costs (p < 0.001); cost differences were mainly driven by an adjusted inpatient cost difference of $8520 (p = 0.003). Dasatinib patients were less adherent, with a PDC value approximately 13% lower compared to nilotinib patients (p = 0.009).
Among CML patients treated with second-line TKIs, nilotinib patients were more adherent and experienced lower healthcare resource utilization, resulting in medical service cost savings compared to dasatinib patients.
比较达沙替尼与尼罗替尼作为二线治疗慢性髓性白血病（CML）患者的治疗方案在医疗资源利用、成本和治疗依从性方面的差异。
合并两个大型回顾性理赔数据库（1999 年 1 月至 2009 年 6 月），以确定接受一种或多种达沙替尼或尼罗替尼处方的 CML 患者（ICD-9 代码 205.1x）。研究患者在索引日期之前和之后连续入组时间至少为 1 个月，索引日期定义为达沙替尼或尼罗替尼的首次处方日期。从索引日期开始，患者最多随访 6 个月，直至医疗计划入组终止或数据可用的最早日期。在研究期间进行骨髓或干细胞移植的患者被排除在外。使用泊松回归模型比较两组之间的医疗资源利用情况。结果以发病率比（IRR）报告。使用广义线性模型或两部分模型为每个成本组成部分估计医疗成本差异。使用广义线性模型测量治疗依从性，以覆盖率（PDC）表示，并进行比较。使用多元回归控制潜在混杂因素。
共纳入 521 例接受二线酪氨酸激酶抑制剂（TKI）治疗的 CML 患者（452 例达沙替尼和 69 例尼罗替尼）。在研究期间，与尼罗替尼患者相比，达沙替尼患者的住院天数估计增加了两倍多（IRR=2.44；p<0.001），住院人数增加了近一倍（IRR=1.99；p=0.047）。在随访期间，达沙替尼患者的总医疗服务费用增加了 8828 美元（p<0.001）；成本差异主要由调整后的住院费用差异 8520 美元驱动（p=0.003）。与尼罗替尼患者相比，达沙替尼患者的依从性较低，PDC 值低约 13%（p=0.009）。
在接受二线 TKI 治疗的 CML 患者中，与达沙替尼患者相比，尼罗替尼患者的治疗依从性更高，医疗资源利用率更低，从而节省了医疗服务成本。
