Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
JCO Oncol Pract. 2021 Apr;17(4):e517-e525. doi: 10.1200/OP.20.00446. Epub 2020 Sep 21.
Azacitidine (AZA) is a standard of care for higher-risk myelodysplastic syndrome (MDS)/low blast-count acute myeloid leukemia (AML). Despite this, there is a paucity of data on the real-world health care resource utilization costs of AZA in this population.
We linked the Ontario AZA MDS registry-higher-risk MDS/low blast-count AML-to population-based health system administrative databases. Patients were observed for 24 months after first AZA and censored at the earliest of 90 days after last AZA, date of death, time of AML induction/stem-cell transplantation, or March 31, 2016. Costs (2015 Canadian dollars) were expressed as standardized mean and median 28-day costs. Univariable quantile regression was used to explore the association of baseline patient and disease characteristics and median cost. Multivariable quantile regression was used to explore predictors of median costs.
Among 877 patients in the registry, mean standardized 28-day cost per patient was $17,638 (median, $15,272; interquartile range [IQR], $11,869-$19,580) and $13,450 (median, $11,043; IQR, $7,981-$14,882) excluding the cost of AZA. Major nondrug drivers of cost were cancer clinic visits and inpatient care (mean standardized 28-day cost, $4,631; median, $1,558; IQR, $238-$4,961). Transfusion dependence at AZA initiation ( = .001) and greater comorbid disease burden ( = .009) were independently associated with increased cost.
Our cohort of patients with uniformly higher-risk MDS/low blast-count AML treated with AZA demonstrates substantial costs of care above and beyond the cost of AZA alone. These results provide insight into the costs of AZA in the real world with implications for resource allocation.
阿扎胞苷（AZA）是治疗高危骨髓增生异常综合征（MDS）/低原始细胞计数急性髓系白血病（AML）的标准治疗方法。尽管如此，在这一人群中，AZA 的实际医疗资源利用成本数据仍然很少。
我们将安大略省 AZA MDS 登记处-高危 MDS/低原始细胞计数 AML 与基于人群的医疗系统行政数据库相链接。患者在首次接受 AZA 后观察 24 个月，并在最后一次接受 AZA 后 90 天、死亡日期、AML 诱导/干细胞移植时间或 2016 年 3 月 31 日最早进行 censoring。（2015 年加拿大元）成本表示为标准化平均和中位数 28 天成本。使用单变量分位数回归来探索基线患者和疾病特征与中位数成本之间的关联。使用多变量分位数回归来探索中位数成本的预测因素。
在登记处的 877 名患者中，每位患者的平均标准化 28 天成本为 17638 加元（中位数为 15272 加元；四分位距 [IQR] 为 11869-19580 加元）和 13450 加元（中位数为 11043 加元；IQR 为 7981-14882 加元），不包括 AZA 的成本。成本的主要非药物驱动因素是癌症诊所就诊和住院治疗（平均标准化 28 天成本为 4631 加元；中位数为 1558 加元；IQR 为 238-4961 加元）。AZA 起始时的输血依赖（ =.001）和更高的合并症负担（ =.009）与成本增加独立相关。
我们的这组接受 AZA 治疗的高危 MDS/低原始细胞计数 AML 患者的队列表明，除了单独使用 AZA 的成本外，护理费用还存在大量支出。这些结果提供了对现实世界中 AZA 成本的深入了解，对资源分配具有重要意义。
