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This section of First Report Managed Care focuses on reporting the latest in health care economics and outcomes research for a variety of treatments and disease states.

Ibrutinib treatment was associated with significantly lower utilization of outpatient services and overall health care costs, compared with traditional chemoimmunotherapy (CIT) treatment in patients with both first- and second-line chronic lymphocytic leukemia (CLL), according to science presented at AMCP Nexus (October 29–November 1, 2019; National Harbor, MD)

Reethi Iyengar, PhD, MBA, MHM, Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, and colleagues conducted a retrospective, observational cohort study using patient data from the IBM Marketscan Commercial Claims and Encounters Database.

A total of 12,783 patients with ­≥1 inpatient or ­≥2 outpatient non-diagnostic claims with a diagnosis of CLL between February 12, 2014 and December 31, 2017 were included. Dr Iyengar and colleagues narrowed parameters to show patients: 18-years and older (n=12,648); with continuous medical and pharmacy benefits enrollment for ­ ≥12 months prior to the date of diagnosis(n=7532); no evidence of CLL in the 12 months prior to the diagnosis date(n=4365); and no evidence of malignancies, antineoplastics, or a hematopoietic stem cell transplant in the 6 months prior to the index date (2734).

The researchers measured health care resource utilization (HRU) and costs for each line of therapy (LOT) by identifying CLL-diagnosis-related claims for services or medications for the 2734 patients that met the inclusion criteria. CLL-specific pharmacy costs include costs from outpatient pharmacy claims as well as office-administered medication claims, explained the poster presenters. HRU outcomes were recorded as per-patient per-month and all adjusted to 2017 US dollars.

HRU tended to be higher for CIT-treated patients than those treated with ibrutinib, according to Dr Iyengar and colleagues. CIT-treated first-line patients had on average more outpatient services claims (7.39 vs 3.51, P<0.001), in particular, more claims for outpatient office visits and other outpatient services than ibrutinib-treated patients (both, P<0.001). The researchers attribute this to antineoplastic drug administration-related services.

Results were similar for patients with second-line CLL outpatient services in that CIT-treated patients had on average more outpatient services claims than ibrutinib-treated patients (8.56 vs 5.51, P=0.029).

“Higher ibrutinib pharmacy costs were fully offset by lower medical costs,” concluded researchers, “driven mostly by costs associated with outpatient services resulting in a net total direct cost reduction on all-cause healthcare (1L: $17,104; 2L: $31,274) as well as CLL-specific costs (1L: $17,353; 2L: $32,375), compared to CIT treatment across both lines.”

—Edan Stanley


Iyengar R, Malangone-Monaco E, Sugg C, et al. Comparison of Healthcare Resource Utilization and Costs for Chronic Lymphocytic Leukemia (CLL) Patients Treated With Ibrutinib or Chemoimmunotherapy. Poster presented at the Academy of Managed Care Pharmacy (AMCP) Nexus; October 29–November 1, 2019; National Harbor, MD, USA.

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