Wang Song, Lafeuille Marie-Hélène, Lefebvre Patrick, Romdhani Hela, Emond Bruno, Senbetta Mekré
a Janssen Scientific Affairs LLC , Horsham , PA , USA.
b Analysis Group Inc , Montréal , Québec , Canada.
Curr Med Res Opin. 2018 Jun;34(6):1135-1142. doi: 10.1080/03007995.2018.1464904. Epub 2018 Apr 25.
This study assessed healthcare costs of first-line treatment failure (TF) in patients with chronic lymphocytic leukemia (CLL), a subtype of non-Hodgkin's lymphoma.
Pre-diagnosis treatment-naïve adults with ≥2 CLL diagnoses initiated on an antineoplastic agent (index date) after their first CLL diagnosis with ≥12 and ≥6 months of continuous observation pre- and post-index, respectively, were selected from the Truven Health MarketScan Research Databases. Patients had no solid malignancies in the pre-index period nor selected blood malignancies at any time. Initial therapy included antineoplastic agents initiated in the first 30 days post-index. TF occurred at the earliest of: initiation of a new antineoplastic agent, treatment resumption following a ≥3 month break, non-chemotherapy intervention (stem cell transplant or radiotherapy), hospice care or hospital mortality. The cost of TF was evaluated as the healthcare cost difference between patients with and without first-line TF using ordinary least square regressions adjusted for baseline characteristics. Non-parametric bootstrap was used to evaluate statistical significance.
Among 2226 patients identified (mean age: 68 years; female: 41%), 46% experienced first-line TF. The average TF cost was $3011 per patient per month (p < .001). When stratifying patients by event indicating TF and by most common therapies, non-chemotherapy intervention ($7582 per patient per month; p < .0001) and fludarabine/cyclophosphamide/rituximab ($4758; p < .001) were associated with the highest TF cost, respectively.
The cost of first-line TF is high and varies across first-line therapies. This should be considered when selecting the initial therapy in these patients.
本研究评估了慢性淋巴细胞白血病（CLL，非霍奇金淋巴瘤的一种亚型）患者一线治疗失败（TF）的医疗费用。
从Truven Health MarketScan研究数据库中选取首次诊断为CLL且诊断前未接受过治疗的成年患者，这些患者在首次CLL诊断后开始使用抗肿瘤药物（索引日期），分别在索引前后连续观察≥12个月和≥6个月。患者在索引前期无实体恶性肿瘤，且在任何时候均无选定的血液系统恶性肿瘤。初始治疗包括索引后30天内开始使用的抗肿瘤药物。TF最早发生于以下情况：开始使用新的抗肿瘤药物、中断≥3个月后恢复治疗、非化疗干预（干细胞移植或放疗）、临终关怀或医院死亡。使用经基线特征调整的普通最小二乘法回归评估TF的费用，即一线TF患者与无一线TF患者之间的医疗费用差异。采用非参数自助法评估统计学显著性。
在确定的2226例患者中（平均年龄：68岁；女性：41%），46%经历了一线TF。平均TF费用为每位患者每月3011美元（p < 0.001）。当按指示TF的事件和最常用的治疗方法对患者进行分层时，非化疗干预（每位患者每月7582美元；p < 0.0001）和氟达拉滨/环磷酰胺/利妥昔单抗（4758美元；p < 0.001）分别与最高的TF费用相关。
一线TF的费用很高，且因一线治疗方法而异。在为这些患者选择初始治疗时应考虑这一点。
