Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
J Med Econ. 2021 Jan-Dec;24(1):234-243. doi: 10.1080/13696998.2021.1876714.
To describe healthcare resource utilization (HRU) and costs in patients with myelodysplastic syndromes (MDS) treated with hypomethylating agents (HMA) based on HMA-treatment response.
SEER-Medicare data (January 2006-December 2016) were used to identify adults diagnosed with MDS (SEER: January 2009-December 2015) initiated on HMA (index date). HMA-treatment success (indicators: ≥7 HMA cycles, stem cell transplantation, and transfusion independence) or failure (indicators: acute myeloid leukemia [AML], AML-like treatment, and death) was determined using a claim-based algorithm. HRU and costs were assessed from the index date to 1-year post-index, overall and stratified by HMA-treatment success or failure. Among patients with HMA-treatment failure, HRU and costs were also assessed from failure to 1-year post-failure.
The study included 3,046 patients (mean age: 77.4 years; females: 36.8%). Rates of HMA-treatment success and failure were 44.4% and 76.2%, respectively (20.6% had HMA-treatment success then failure). Overall, patients had 15.2 inpatient admissions per-100-patients-per-month (median follow-up: 5.9 months). Patients with HMA-treatment success had 7.5 inpatient admissions per-100-patients-per-month (median follow-up: 12.0 months), while those with HMA-treatment failure had 20.4 and 35.3 admissions per-100-patients-per-month pre- and post-HMA-treatment failure, respectively (median follow-up: 4.3 and 1.8 months, pre- and post-HMA-treatment failure, respectively). Mean total healthcare costs were $12,494 per-patient-per-month overall, $8,069 per-patient-per-month among patients with HMA-treatment success, and $13,809 and $19,242 per-patient-per-month pre- and post-HMA-treatment failure, respectively. Outpatient costs (68.3%) were the main contributor of total healthcare costs overall, while inpatient costs (80.3%) were the main cost driver post-HMA-treatment failure.
Without available laboratory test results, clinical indicators observed in claims were used to assess HMA-treatment response.
Over 75% of patients with MDS failed HMA-treatment within 6 months of initiation and were observed with more inpatient admissions than those with HMA-treatment success, translating into substantially higher healthcare costs. HMA-treatment failure results in an important economic burden in MDS patients.
根据低甲基化药物（HMA）治疗反应，描述接受 HMA 治疗的骨髓增生异常综合征（MDS）患者的医疗资源利用（HRU）和成本。
使用 SEER-Medicare 数据（2006 年 1 月至 2016 年 12 月），确定了 2009 年 1 月至 2015 年 12 月期间被诊断为 MDS 的成年人（SEER），他们接受了 HMA 治疗（索引日期）。使用基于索赔的算法确定 HMA 治疗成功（指标：≥7 个 HMA 周期、干细胞移植和输血独立性）或失败（指标：急性髓细胞白血病[AML]、AML 样治疗和死亡）。从索引日期到索引后 1 年评估 HRU 和成本，总体上和根据 HMA 治疗成功或失败进行分层。在 HMA 治疗失败的患者中，还从失败到失败后 1 年评估了 HRU 和成本。
该研究包括 3046 名患者（平均年龄：77.4 岁；女性：36.8%）。HMA 治疗成功和失败的比例分别为 44.4%和 76.2%（20.6%先成功后失败）。总体而言，每位患者每月每 100 名患者中有 15.2 次住院（中位随访：5.9 个月）。HMA 治疗成功的患者每月每 100 名患者中有 7.5 次住院，而 HMA 治疗失败的患者在 HMA 治疗失败前和失败后分别有 20.4 和 35.3 次住院/100 名患者/月，中位随访分别为 4.3 和 1.8 个月（分别为 HMA 治疗失败前和失败后）。总体而言，每位患者每月的医疗保健费用为 12494 美元，HMA 治疗成功的患者每月为 8069 美元，HMA 治疗失败前和失败后分别为 13809 美元和 19242 美元。门诊费用（68.3%）是总体医疗保健费用的主要贡献者，而 HMA 治疗失败后住院费用（80.3%）是主要的成本驱动因素。
由于没有可用的实验室检测结果，索赔中观察到的临床指标用于评估 HMA 治疗反应。
超过 75%的 MDS 患者在开始 HMA 治疗后 6 个月内治疗失败，与 HMA 治疗成功的患者相比，这些患者的住院次数更多，导致医疗保健费用大幅增加。HMA 治疗失败会给 MDS 患者带来重大的经济负担。
