title: Economic Burden of Tyrosine Kinase Inhibitor Treatment Failure in Chronic Myeloid Leukemia.
abstract: BACKGROUND
  The economic burden of tyrosine kinase inhibitor (TKI) treatment failure in chronic myeloid leukemia (CML) is not well understood. The objective of this study was to quantify the economic burden associated with treatment failure versus successfully remaining on TKI therapy.
  
  
  METHODS
  Treatment episodes for adult CML patients initiating a TKI of interest (imatinib, dasatinib, or nilotinib; index TKI) during July 1, 2008, to December 31, 2011, with continuous enrollment for ≥ 120 days before and 1 year after the initiation were identified from the IMS PharMetrics Plus Health Plan Claims Database. Eligible episodes of TKI treatment failure were matched to those without failure using propensity scores based on patients' baseline demographic and clinical characteristics. Treatment failure was defined as a switch to a nonindex TKI or discontinuation (gap in pharmacy claims ≥ 60 days) of index TKI over the 1-year follow-up. Mean all-cause health care resource utilization and costs per episode (in 2012 US dollars) over follow-up were compared between failures and nonfailures.
  
  
  RESULTS
  Among 1774 eligible episodes, 547 failures were matched to 547 nonfailures. Failures had fewer TKI prescription fills but higher utilization of all other services versus nonfailures. Consequently, failures incurred lower pharmacy costs ($51,238 vs. $72,450; Δ-$21,212) but higher medical costs ($52,619 vs. $18,180; Δ$34,439) than nonfailures, resulting in higher total costs ($103,857 vs. $90,630; Δ$13,227) (all P < .05).
  
  
  CONCLUSIONS
  Total health care costs are higher for episodes of TKI treatment failure than those of ongoing treatment, largely as a result of costly medical (nonpharmacologic) services. Avoiding treatment failure by optimal CML management may reduce health care costs.
authors.affiliation: California Pacific Medical Center, San Francisco, CA.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Knopf
authors.affiliation: IMS Health, Fairfax, VA. Electronic address: vdivino@us.imshealth.com.
authors.forename: Victoria
authors.initials: V
authors.lastname: Divino
authors.affiliation: ARIAD Pharmaceuticals Inc, Cambridge, MA.
authors.forename: Lisa
authors.initials: L
authors.lastname: McGarry
authors.affiliation: IMS Health, Fairfax, VA.
authors.forename: Yaozhu J
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: IMS Health, Fairfax, VA.
authors.forename: Shibani
authors.initials: S
authors.lastname: Pokras
authors.affiliation: IMS Health, Fairfax, VA.
authors.forename: Julie
authors.initials: J
authors.lastname: Munakata
authors.affiliation: ARIAD Pharmaceuticals Inc, Cambridge, MA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Taylor
authors.affiliation: ARIAD Pharmaceuticals Inc, Cambridge, MA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ng
authors.affiliation: ARIAD Pharmaceuticals Inc, Cambridge, MA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nieset
authors.affiliation: ARIAD Pharmaceuticals Inc, Cambridge, MA.
authors.forename: Hui
authors.initials: H
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors
keywords: Cost analysis; Economic cost; Health services research; Retrospective data; Treatment failure