Healthcare Costs in Elderly Patients with Acute Myeloid Leukemia (AML) in Routine Clinical Care in the United States (US)

Background: No recent studies have evaluated the healthcare burden of elderly AML patients in the US. We evaluated healthcare costs of treated and untreated patients receiving routine clinical care in the US.

Methods: Newly diagnosed AML patients age >=60 years were retrospectively identified from the Optum claims database, between 1/1/2008-10/30/2015. AML diagnosis included: >=1 inpatient or >=2 outpatient claims with an AML ICD-9/10 code (205.0, C92.5x, C92.6x, C92.9x, and C92.Ax); the first record served as the index date. Patients who initiated treatment with chemotherapy or stem cell transplant (SCT) after the index date were considered to be treated and were followed from the index date until end of continuous enrollment, death, or end of study period (12/31/15)for the assessment of AML- and non-AML-related costs. AML-related costs were medical claims with a primary diagnosis of AML or AML treatment (ie, chemotherapy, stem cell transplant, and supportive care) and pharmacy claims for AML treatment. Costs were calculated as per-patient-per-month (PPPM) costs and reported as mean and standard deviation (SD). Patients with a capitated payment plan were excluded from the cost analysis and costs were standard to 2015 dollars.

Results: A total of 237 treated elderly AML patients were included in the study. Mean age was 73.1 years, 60.3% were male, and 29.5% of patients had a Charlson Comorbidity Index (CCI) score of ³2 and 24.9% had a CCI score of 1. During the entire follow-up, the mean total cost was $25,243 PPPM (SD: $21,909); costs incurred in Year 1 of AML diagnosis ($27,756 PPPM [SD: $22,121]) were almost double the costs incurred in Year 2 of AML diagnosis ($12,953 PPPM [SD: $26,334]) (Table 1). Total costs overall, and in Years 1 and 2 were mostly comprised of medical costs. In Year 1, total medical costs were $24,512 PPPM (SD: $21,704); 64% of which was AML-related costs. By Year 2, total medical costs decreased to $12,309 PPPM (SD: $26,339); 39% of which was AML-related costs. The observed decrease in medical costs from Year 1 to Year 2 was likely due to the cost associated with AML diagnosis being captured in Year 1. In the first month following AML diagnosis, medical costs were $81,828 PPPM (SD: $73,869), with AML-related medical costs accounting for 74% of the costs. In the second month, medical costs decreased to $25,652 (SD: 35,865) and between 10-12 months, medical costs were $14,725 (SD: 37,534), with AML-related costs accounting for 44% of the costs. Of the medical cost components, inpatient costs, particularly AML-related costs, had the most decrease between Year 1 and 2. Other contributors in the decrease in medical costs are costs associated with chemotherapy administration, supportive care treatment, and non-physician office outpatient services.

Conclusions: Healthcare costs of treated elderly AML patients are substantial, particularly in the first year following diagnosis. Costs in the second year after diagnosis decreased mainly due to the cost of diagnosis being captured in Year 1 and also more patients receiving treatment Year 1, but costs still remained high. Further research is needed to understand factors contributing high costs in various settings of care in elderly AML patients.

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