BACKGROUND: In third-line or later (3L+) CLL, there is no standard of care after failure of oral-targeted treatments (tx) (eg, BTKi, B-cell lymphoma 2 inhibitor [BCL2i]). There is limited real-world evidence on tx received and economic burden among pts with advanced CLL. Therefore, this study assessed tx patterns, health care resource utilization (HCRU), and costs in 3L+ Medicare-enrolled pts with CLL who received prior BTKi.
METHODS: A retrospective study was conducted using SEER data from 2010 to 2017 linked to Medicare claims data through 12/31/2019. Eligible pts had a CLL diagnosis, were ≥ 66 y of age at diagnosis, received ≥ 2 prior LOTs, including a BTKi, and initiated a subsequent LOT. Index date was defined as start of 3L+ tx after discontinuation of prior LOT containing a BTKi. Pts were continuously enrolled in Medicare parts A, B, and D ≥ 6 mo before and ≥ 1 mo after index date. Baseline pt characteristics, HCRU, and associated health care costs in the postindex period were summarized descriptively. HCRU and costs (adjusted to 2019 US dollars) were reported as mean CLL-related and all-cause per pt per month (PPPM).
RESULTS: Among 98 eligible pts with post-BTKi 3L+ CLL, mean age was 78 y; 54.1% were male. Pts had a median of 2 prior LOTs with median postindex follow-up of 12 mo. Mean Charlson Comorbidity Index score was 2.8. The top 3 index LOT txs received were chemotherapy with anti-CD20 monoclonal antibodies (mAb [19.4%]), anti-CD20 mAb monotherapy (19.4%), and BCL2i monotherapy (14.3%). In the postindex period, 90.8% of pts had ≥ 1 office visit; 63.3% had ≥ 1 inpatient admission with a mean length of stay of 7.6 d. All-cause mean PPPM HCRU was 2.3 office visits, 1.8 hospital outpatient visits, 0.02 skilled nursing facility (SNF) visits, 1.6 ancillary care visits, 0.2 emergency room (ER) visits, and 0.2 inpatient admissions. Total all-cause mean (standard deviation [SD]) PPPM cost was $12,679 ($15,123). The main drivers of total all-cause PPPM cost were inpatient admissions ($4891) followed by drugs ($4379), hospital outpatient ($2338), office visits ($412), ancillary care ($412), SNF ($140), and ER ($26). CLL-related HCRU and costs are shown in the Table. CLL-related PPPM costs accounted for 83% of total all-cause costs with a mean (SD) of $10,501 ($14,052).
CONCLUSIONS: Our study demonstrated that Medicare-enrolled pts with 3L+ CLL who received prior BTKi experienced high economic burden (mean monthly cost of $12,679). Inpatient admissions and drugs were the largest cost drivers. Considering the survival in this population (median OS of 33.1 mo; Awan et al. Blood 2022), the lifetime economic burden to Medicare could b
