Abstract
Background: Real-world data on treatment patterns and economic burden associated with rrHL are limited. The study aimed to describe BV utilization, post-BV therapies, health care resource utilization (HCRU) and costs among rrHL patients treated with BV in US clinical practice.
Methods: This is a retrospective database analysis of the Truven Health MarketScan Commercial and Medicare Database. Patients were included if they initiated BV treatment for HL between Jan 1, 2012 and Jun 30, 2014, were ≥18 yrs, and had ≥6 mos continuous enrollment before and after the 1st BV dose (index date). If two or more drugs were started within 30 days, they were considered as one regimen. Line of therapy (LOT) was defined when a new treatment was introduced or there was a treatment gap >60 days. Time to next treatment (TTNT) was defined from initiation of the LOT to initiation of subsequent LOT. Duration of treatment (DOT) and TTNT were evaluated based on Kaplan-Meier method. HCRU (events/person-months) and costs (per patient per month, PPPM) were calculated by LOT. The total costs included inpatient costs, outpatient costs and pharmacy costs.
Results: A total of 219 patients were included in the study. On average, patients were observed for 2.7 yrs prior to and 1.1 yrs post to initiation of BV. During the observational period, 88 patients had transplant (SCT), including 50 having SCT prior to initiation of BV. Median age at index date was 46 yrs among all patients and 40 yrs among patients with SCT. For BV, median DOT was 2.1 mos and TTNT was 6.2 mos. Rate of outpatient visits, inpatient visits, ER visits and hospice care visits, per person-month, were 5.04, 0.08, 0.09, and 0.09, respectively. Mean total costs per person was $167,152, with outpatient costs being the largest cost driver ($144,583). Mean PPPM cost was $24,593. Of the 219 patients, 126 (57.5%) patients received subsequent systemic therapy (ST) after discontinuing BV. For subsequent ST post-BV, median DOT was 1.5 mos with BV (12.8%a), GVD/GV (10.5%), bendamustine (6.8%) gemcitabine (4.6%) and fludarabine (1.8%) being most common. Rate of outpatient visits, inpatient visits, ER visits and hospice care visits, per person-month, were 5.84, 0.18, 0.10, and 0.01, respectively. Mean total costs per person were $139,146, inpatient costs were $69,043, and outpatient costs were $65,233. Mean PPPM cost was $28,290.
Conclusions: Short duration of therapy was observed for both BV and subsequent ST post-BV. Costs over $24K per month were incurred for each patient during BV treatment course and over $28K per month during subsequent ST post-BV course. Findings underscore substantial economic burden in rrHL patients treated with BV.
Shao:Merck & Co., Inc.: Employment. Liu:Merck & Co., Inc.: Employment. Zhou:Merck & Co.: Employment. Raut:Merck & Co.: Employment. Monberg:Merck & Co.: Employment. Cao:Merck & Co.: Employment. Ricart:Pfizer: Equity Ownership; Merck & Co.: Employment. Balakumaran:Merck & Co.: Employment, Other: stock, stock options.
