Economic burden of relapse in patients with acute lymphoblastic leukemia: A retrospective claims-based analysis Free

Introduction:Acute lymphoblastic leukemia (ALL) imposes substantial disease burden and high healthcare resource utilization (HCRU) and costs. Although overall survival has improved with modern therapies, including immunotherapies, HCRU and costs remain high, particularly among patients who relapse. Historical studies have shown that patients who relapse experience lengthy, high-cost hospitalizations for chemotherapy administration. These studies reflect data through 2016 and, in large part, do not account for more recent treatment advances. This study estimates HCRU and costs among newly diagnosed ALL patients with and without relapse to characterize the current economic burden of relapse.

Methods:Patients with newly diagnosed ALL enrolled in the MarketScan paid claims database (2015-2024) were included. The index date was defined as the first inpatient claim or the first of 2 outpatient claims for ALL occurring 30 days apart. Patients were required to have ≥180 days of continuous pre-index enrollment, ≥30 days post-index enrollment, and evidence of treatment initiation or transplantation. To ascertain relapse status, patients were required to have ≥1 diagnosis code indicative of remission (ICD-9: 204.01; ICD-10: C91.01) and/or relapse (ICD-9: 204.02; ICD-10: C91.02) during follow-up. Patients were followed from index date for up to 3 years and censored upon disenrollment, last ALL-related claim, or end of data availability. Patients with ≥1 relapse diagnosis were grouped as relapse, regardless of number of relapse events. HCRU and cost outcomes were standardized to per-patient-per month (PPPM) and trimmed at the 99th percentile.

PPPM costs and HCRU were calculated in 30-day intervals over the 3-year period to observe monthly variations. Patients contributed data only to intervals before censoring. To estimate the projected cumulative 3-year HCRU and cost burden, PPPM estimates across all intervals were summed, modeling the trajectory a patient might accrue if followed for the full 3 years. Among relapse patients, results are also reported by pre- (since index date) and post-relapse time periods. All results are presented by relapse status (relapse vs. remission) and by age group (adult vs. pediatric).

Results: A total of 520 adult and 871 pediatric newly diagnosed ALL patients were included. Baseline demographics, including age, sex, year of index date, modified Charlson Comorbidity Index, and geographic region were comparable between remission and relapse groups.

Among adults, the projected 3-year cumulative all-cause cost was substantially higher for relapse patients, $1,348,240, compared to those in remission, $939,705, resulting in a projected cost difference of $408,536 over 3 years. Among adult patients who relapse, mean post-relapse PPPM costs were higher than pre-relapse costs, $106,507 and $95,378, respectively, over a 3-year period.

In the pediatric population, the projected cumulative 3-year costs were $1,105,114 for patients who relapsed and $726,463 for those in remission, yielding a projected cost difference of $378,651 over the 3-year period. Mean total PPPM costs for pediatric patients who relapsed were $86,105 pre-relapse vs. $142,527 post-relapse over the 3-year follow-up. Post-relapse costs were highest in the first 30 days after relapse for both adult and pediatric patients with an estimated mean PPPM of $162,213 and $279,136, respectively.

In adult and pediatric patients, the largest cost driver was inpatient costs. Over the 3-year period, adult and pediatric patients who relapsed had on average 4 more inpatient admissions and 54 and 57 more inpatient days, respectively, compared to patients in remission.

For both adult and pediatric patients, similar trends were observed in ALL-related costs and HCRU.

Conclusions:The HCRU and cost burden of treating ALL is high, and relapse contributes an additional 40–50% increase in cumulative costs for both adult and pediatric patients. Given that the best opportunity for cure occurs in the frontline setting, it is clinically and economically imperative to invest in the most effective therapies early in the treatment course to reduce relapse risk and long-term burden.