Acute Myeloid Leukemia (AML): A Retrospective Claims Analysis of Resource Utilization and Expenditures

Motivation/Objectives: The primary objective of this study was to estimate resource utilization and expenditures for de novo (dn) AML patients in a real world claims database.

Sponsorship Statement: This study was sponsored by Pfizer, Inc.

Methods: All AML patients with an ICD-9 diagnosis code of 205.00 (dn) and a record of a hospitalization within 14 days after their initial diagnosis between 1/1/2009 - 1/31/2015 were identified in the MarketScan Commercial, Medicaid, and Medicare supplemental databases. Patients also had to have a minimum of two instances of the AML diagnosis code and ≥6 mos of enrollment prior to their first AML diagnosis. Patient demographics, Charlson Comorbidity Index from the National Cancer Institute (CCI NCI), risk factors for AML, such as history of smoking and blood disorders, and key comorbid conditions were recorded. Age at initial diagnosis was grouped as follows: <18, 18-<50, 50-70 and >70 years. Healthcare utilization and expenditures (in 2014 dollars) were aggregated for dn patients from first line induction to remission. For the subset of patients that had a record of relapse and remission following induction, their healthcare utilization and expenditures were aggregated from the time of relapse to their second remission.

Results: Of the 1,671 patients meeting the inclusion criteria the mean (SD) age was 58.3 (16.7). Age at initial diagnosis by group was as follows: less than 18 years, 0.4%; 18 to 50 years, 26.5%; 50 to 70 years, 49.7%; and greater than 70 years, 23.5%. Male patients made up 51% of the cohort and mean (SD) CCI NCI score for all patients was 1.1 (1.6). Over 90% of patients had at least one risk factor for AML, with 88% of patients having a history of blood disorders. Mean healthcare expenditures for patients who achieved remission (n=703) were $208,431 (SD $153,144). A subset of patients (n=145) had a record of a second treatment period defined as days from their first record of relapse to their second remission. During this second treatment period, mean healthcare expenditures were $127,953 (SD $175,020); 61.4% were admitted to the hospital for an average of 16.8 hospital days; and 22.8% had at least one ER visit.

Conclusions: Treating AML patients poses a significant healthcare burden, both during de novo and relapse. With people living longer, the number of cases of AML are expected to increase in the future.