Predictors of Increase in Emergency Room (ER) Visits and Hospitalizations in Patients with Chronic Lymphocytic Leukemia (CLL) Treated with Chemotherapy

Background: Acute care interventions negatively impact patients' quality of life and represent one of the major cost drivers in oncology care. Understanding the predictors for increased healthcare resource utilization is essential for better management of patients with CLL. This study evaluated predictors for ER visits and hospitalizations in patients with CLL treated with chemotherapy.

Methods: Using claims data (MORE² Registry^®), patients receiving chemotherapy for CLL were retrospectively identified by ICD-9 codes (204.1X) during a 48-month period (August 2009-2013). Patients with secondary malignancies, pregnancy codes, and age <18 were excluded. Univariate regression analysis was conducted to determine covariates associated with an increase in ER visits and hospitalizations. Results for significant variables were reported as odds ratio/p-value. Odds ratio >1 indicates increase in chance of event.

Results: A total of 2,013 patients with CLL were identified. Median age at diagnosis was 72 years, 61% were male, 34% were treated in the relapsed setting, 42% had ER visits, and 39% were hospitalized throughout their treatment history. Significant increases in ER visits and hospitalizations were associated with the following variables (OR/p-value): age (ER: 1.015/.001, hospitalization: 1.001/.038), Charlson comorbidity index (ER: 1.253/.013, hospitalization: 1.038/.018), supportive care use (ER: 2.087/<.001, hospitalization: 2.429/<.001), number of CLL related adverse events (ER: 12.311/<.001, hospitalization: 29.467/<.001), chemotherapy duration (ER: 1.001/<.001, hospitalization: 1.001/<.001), bendamustine use (ER: 1.404/.001, hospitalization: 1.381/.002), fludarabine use (ER: 1.405/<.001, hospitalization: 1.395/.001), Northeast region of the United States (ER: 1.293/.008, hospitalization: 1.321/.005), and treatment following relapse (ER: 3.413/<.001, hospitalization: 4.018/<.001). Significant covariates associated with a decrease in hospitalizations or ER visits were not found.

Conclusions: This retrospective study demonstrated that patient demographic and clinical characteristics as well as chemotherapy choice were associated with ER visits and hospitalizations in patients with CLL. ER visits and hospitalizations have similar drivers. These data warrant consideration of age and comorbidity-adjusted treatment choice in CLL patients who need active treatment with antineoplastics.