title: Linking Costs and Survival in the Treatment of Older Adults With Chronic Myeloid Leukemia: An Analysis of SEER-Medicare Data From 1995 to 2007.
abstract: BACKGROUND
  The high prices of chronic myeloid leukemia (CML) therapy are well recognized, but less discussion has focused on the value of health care spending on the disease. This study examined whether the added costs have been "worth" the benefits among older adults with CML.
  
  
  METHODS
  We analyzed trends in health care costs and survival over time of 2164 CML patients over age 65 using the Surveillance, Epidemiology and End Results-Medicare-linked database. We estimated life expectancy over a 15-year duration after diagnosis using a Weibull survival model and projected the corresponding costs using a 2-part model, adjusting for patient characteristics. We estimated population-level survival, total health care costs, and incremental cost-effectiveness ratios (expressed as cost per life year gained) over the period of 1995-2007.
  
  
  RESULTS
  We found that therapeutic improvements in the treatment of CML have been associated with survival gains among older adults. Mean life expectancy was 2.2 years in 1995 and increased to 4.2 years in 2007. During the same timeframe, CML care costs have increased, from $127,000 in 1995 to $278,000 in 2007 (2010 dollars), mostly due to increasing tyrosine kinase inhibitor costs. The aggregated incremental cost-effectiveness ratio was $74,000/life year gained.
  
  
  CONCLUSIONS
  Our findings showed that, despite high costs, CML care may provide reasonable value for money among older patients between 1995-2007. Our study sheds light on the value of health care spending on CML by considering both the costs and the benefits. Future research should investigate strategies to improve treatment adherence to maximize the value of CML care.
authors.affiliation: *Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA †Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC ‡Center for Health Solutions, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA §Patient Access and Outcomes, The Leukemia & Lymphoma Society, White Plains, NY.
authors.forename: Pei-Jung
authors.initials: PJ
authors.lastname: Lin
authors.forename: Aaron N
authors.initials: AN
authors.lastname: Winn
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Neumann
authors.forename: Elisa S
authors.initials: ES
authors.lastname: Weiss
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000191:economics* / Q000401:mortality* / Q000628:therapy*; D008017:Life Expectancy / Q000639:trends; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States
chemical_list: D000970:Antineoplastic Agents