New York Medical College, Valhalla, NY, USA.
Analysis Group, Inc., Montreal, QC, Canada.
Adv Ther. 2018 Oct;35(10):1671-1685. doi: 10.1007/s12325-018-0772-3. Epub 2018 Aug 28.
Tyrosine kinase inhibitors (TKI) have been demonstrated to prolong survival in patients with chronic myeloid leukemia (CML). However, TKIs may be associated with an increased risk of infections. This study compared healthcare resource utilization (HRU) and costs among patients with CML receiving dasatinib or nilotinib, with a focus on infection-related economic outcomes.
Two large administrative databases were used to identify adult patients newly diagnosed with CML who initiated dasatinib or nilotinib as first- (1L) or second-line (2L) therapy and were classified into the following 1L (dasatinib 1L/nilotinib 1L cohorts) or 2L (dasatinib 2L/nilotinib 2L) cohorts based on the initiated 1L/2L TKI therapy. Infection-related HRU and healthcare costs were compared between cohorts, separately for 1L and 2L.
Cohorts included 1156 patients in the dasatinib 1L and 677 patients in the nilotinib 1L cohorts, 322 patients in the dasatinib 2L, and 207 in the nilotinib 2L cohorts. In 1L and 2L, infection-related HRU was higher for dasatinib than nilotinib cohorts. Infection-related inpatient (IP) days constituted a larger proportion of all-cause IP days in the 1L/2L dasatinib than 1L/2L nilotinib cohorts (dasatinib 1L/2L: 53%/58%; nilotinib 1L/2L: 50%/46%). Compared to the nilotinib cohort, the dasatinib cohort had higher all-cause total costs per patient per year by US$17,901 in 1L and $28,625 in 2L. Of the total cost difference, infection-related were $6048 (34%) in 1L and $28,192 (99%) in 2L, largely driven by IP cost differences (1L/2L: 96%/98%).
Dasatinib was associated with higher HRU and healthcare costs compared to nilotinib, particularly related to infections.
Novartis Pharmaceutical Corporation.
酪氨酸激酶抑制剂（TKI）已被证明可延长慢性髓性白血病（CML）患者的生存期。然而，TKI 可能与感染风险增加相关。本研究比较了接受达沙替尼或尼洛替尼治疗的 CML 患者的医疗资源利用（HRU）和成本，重点关注与感染相关的经济结果。
使用两个大型行政数据库，确定新诊断为 CML 的成年患者，他们开始接受达沙替尼或尼洛替尼作为一线（1L）或二线（2L）治疗，并根据起始的 1L/2L TKI 治疗将其分为以下 1L（达沙替尼 1L/尼洛替尼 1L 队列）或 2L（达沙替尼 2L/尼洛替尼 2L 队列）。分别比较了 1L 和 2L 时，与感染相关的 HRU 和医疗保健成本。
达沙替尼 1L 队列包括 1156 例患者，尼洛替尼 1L 队列包括 677 例患者，达沙替尼 2L 队列包括 322 例患者，尼洛替尼 2L 队列包括 207 例患者。在 1L 和 2L 中，与尼洛替尼相比，达沙替尼与感染相关的 HRU 更高。与感染相关的住院（IP）天数在 1L/2L 达沙替尼比 1L/2L 尼洛替尼队列中占所有原因 IP 天数的比例更大（达沙替尼 1L/2L：53%/58%；尼洛替尼 1L/2L：50%/46%）。与尼洛替尼队列相比，达沙替尼队列在 1L 时每位患者每年的所有原因总费用高出 17901 美元，在 2L 时高出 28625 美元。在总成本差异中，与感染相关的费用为 1L 时为 6048 美元（34%），2L 时为 28192 美元（99%），主要是由于 IP 成本差异（1L/2L：96%/98%）。
与尼洛替尼相比，达沙替尼与更高的 HRU 和医疗保健成本相关，特别是与感染相关。
诺华制药公司。
