Treatment patterns and healthcare costs among newly-diagnosed patients with chronic myeloid leukemia receiving dasatinib or nilotinib as first-line therapy in the United States.
OBJECTIVE
To compare treatment patterns and economic outcomes of dasatinib and nilotinib as 1st-line therapies for chronic myeloid leukemia (CML).


METHODS
Adult CML patients initiated on first-line dasatinib or nilotinib in 2010-2014 were identified from two large US administrative claims databases. Treatment patterns, tyrosine kinase inhibitor (TKI) adherence and healthcare resource utilization (HRU) and costs were measured from the 1st-line TKI initiation (index date) to the end of follow-up.


RESULTS
A total of 604 and 418 patients were included in the dasatinib and nilotinib cohorts (mean ages = 50.9 and 52.5 years, 46.4% and 45.7% female), respectively. Among the dasatinib patients, 91% started with 100 mg/day, 3% with <100 mg/day, and 6% with >100 mg/day. Among the nilotinib patients, 76% started with 600 mg/day, 16% with >600 mg/day, and 8% <600 mg/day. The dasatinib cohort had a higher hazard of dose decrease (hazard ratio [HR] = 1.66; p = .002) and of switching to another TKI (HR =1.62; p = .019) compared to the nilotinib cohort. The hazard of dose increase (HR =0.76; p = .423) and treatment discontinuation (HR =1.10; p = .372) were not significantly different between cohorts. There was also no significant difference in TKI adherence levels (mean proportion of days covered [PDC] difference over first 6 months = -0.0003, p = .981; mean PDC difference over first 12 months = -0.0022, p = .880) and HRU (inpatient day incidence rate ratio [IRR] = 1.03, p = .930; emergency room IRR =1.26, p = .197; and days with outpatient services IRR = 1.01, p = .842). The dasatinib cohort incurred higher healthcare costs by $749 per patient per month (p = .044) compared to the nilotinib cohort.


CONCLUSIONS
Information on CML phase and Sokal score was not available.


CONCLUSIONS
Dasatinib was associated with an increased hazard of dose decrease and switching to another TKI and higher healthcare costs, vs nilotinib.
a Analysis Group, Inc. , Montreal , QC , Canada.
Dominick
D
Latremouille-Viau
a Analysis Group, Inc. , Montreal , QC , Canada.
Annie
A
Guerin
a Analysis Group, Inc. , Montreal , QC , Canada.
Roy
R
Nitulescu
a Analysis Group, Inc. , Montreal , QC , Canada.
Patrick S
PS
Gagnon
b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
George J
GJ
Joseph
b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
Lei
L
Chen
D015331:Cohort Studies; D003430:Cross-Sectional Studies; D000069439:Dasatinib / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D016016:Proportional Hazards Models; D047428:Protein Kinase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use; D014481:United States
D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; C498826:nilotinib; D000069439:Dasatinib
Chronic myeloid leukemia; Costs; Dasatinib; First-line; Nilotinib; Treatment patterns; Tyrosine kinase inhibitor