Abstract
Aim
The data of CLL patients from 12 centers were recorded with an aim of constructing a nationwide CLL registry. We present the retrospective arm of the data obtained, with an emphasis on analysis of cost related parameters.
Method
761 patients included in the retrospective arm. SAS 9.4 was used to analyze data.
Results
63.34 % of patients were male, and the median age at diagnosis was 62.37 (25-92). Median follow up of all patients was 42 months. Overall 7.75 percent of patients died during follow up. Among 252 (35.14% of all patients) patients who required CLL specific therapy, rate of death was 12.5%. Among patients who required therapy 70% received one line, 18% received two lines and 13% received three or more lines of therapy. Fludarabin based therapies leaded front-line therapies by 47.60%, chlorambucil followed fludarabin based therapies by 26.2%. Considering the second line therapies most patients received either bendamustine based therapies or novel agents. Overall response achieved by front line therapies was 84% with a CR rate of 48%. Remission rates declined by further lines of therapy. In patients undergoing front-line therapy, del17p rate was %5.3, and del17p was the worst prognostic factor regarding therapy response and outcome. Among all patients median OS was not achieved, and 10 years OS rates for patients requiring therapy was 63,5% which was significantly less than patients who did not require therapy (p=0.027).
Cost analysis data, which included duration of hospitalization, total number of specialist visits and G-CSF use, was available for 115 patients. Treatments were classified as fludarabine (FCR- fludarabine, cyclophosphamide, rituximab), bendamustine (benda) and chlorambucil (clb) based. Benda and clb chemotherapy consisted of anti CD20 treatment or not. Median treatment durations were 6 cycles for FCR, 6 cycles for benda and 7.4 months for clb arm. Hospitalization days and G-CSF administration rate was significantly higher in FCR arm compared to benda and clb arms altough mean age in FCR arm was lower. There was a slight significance in terms of specialist visits between FCR and benda arms. No statistical significance was noted between benda and clb regarding age and other cost related parameters (Table 1).
Conclusion
This study confirms that the costs for FCR therapy is higher due to its toxicity. Lack of statistical significance between FCR and Clb regarding hospitalization duration and specialist visits might be related with older age of Clb arm. Cost related information in CLL treatment is becoming more important for reimbursement decisions of new generation expensive drugs. Cost effectiveness ratios should be calculated both in daily practice and clinical trial setting using data from prospective patient registries.
No relevant conflicts of interest to declare.
