title: Economic benefits of adequate molecular monitoring in patients with chronic myelogenous leukemia.
abstract: OBJECTIVE
  Molecular monitoring of chronic myeloid leukemia (CML) has been associated with improved clinical outcomes during tyrosine kinase inhibitor therapy (TKI), yet recent studies have demonstrated its use is far below published guidelines. This study sought to determine frequencies of molecular monitoring and its impact on resource utilization and medical costs.
  
  
  METHODS
  A retrospective US claims administrative database (IMS LifeLink Health Plan Claims and Truven Health Analytics MarketScan databases, 11/2007-06/2012) was used to analyze the economic impact of qPCR testing in CML patients on first-line TKIs during the initial 12-months of treatment.
  
  
  RESULTS
  One thousand two hundred and five adult CML patients met the sample selection criteria. Among these, 41.0% had no qPCR tests, 31.9% had 1-2 tests, and 27.1% had 3-4 tests; 88.9% were initiated on imatinib; 47.7% were female. Patients in the 3-4 tests cohort incurred 44% (p < 0.001) fewer in-patient (IP) admissions than patients in the 0-tests cohort. Adjusted all-cause IP cost was $5663 (p = 0.005) lower for the 3-4 tests cohort than the 0-tests cohort. Adjusted progression-related IP cost was $4132 (p = 0.013) lower for the 3-4 tests cohort than the 0-tests cohort. Adjusted medical service cost was $5997 (p = 0.049) lower for the 3-4 tests cohort than the 0-tests cohort.
  
  
  CONCLUSIONS
  Claims databases did not include information on the primary cause of hospitalizations.
  
  
  CONCLUSIONS
  Among CML patients in two large claims databases, nearly three-quarters did not receive adequate molecular monitoring per published guidelines. Those who were more frequently monitored incurred lower medical service costs, with the majority of the difference in costs being related to disease progression. These findings underscore the clinical and economic values of molecular monitoring in CML.
authors.affiliation: Analysis Group, Inc. , Boston, MA , USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Guérin
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Katherine
authors.initials: K
authors.lastname: Dea
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldberg
mesh_terms: D001549:Benzamides / Q000627:therapeutic use*; D005260:Female; D016313:Genes, abl / Q000235:genetics; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D000068877:Imatinib Mesylate; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction / Q000191:economics*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D012333:RNA, Messenger; D012189:Retrospective Studies; D014481:United States
chemical_list: D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D012333:RNA, Messenger; D000068877:Imatinib Mesylate