title: Healthcare Costs and Utilization for Patients Age 50 to 64 Years with Acute Myeloid Leukemia Treated with Chemotherapy or with Chemotherapy and Allogeneic Hematopoietic Cell Transplantation.
abstract: The primary aim of this study was to describe healthcare costs and utilization during the first year after a diagnosis of acute myeloid leukemia (AML) for privately insured non-Medicare patients in the United States aged 50 to 64 years who were treated with either chemotherapy or chemotherapy and allogeneic hematopoietic cell transplantation (alloHCT). MarketScan (Truven Health Analytics) adjudicated total payments for inpatient, outpatient, and prescription drug claims from 2007 to 2011 were used to estimate costs from the health system perspective. Stabilized inverse propensity score weights were constructed using logistic regression to account for differential selection of alloHCT over chemotherapy. Weighted generalized linear models adjusted costs and utilization (hospitalizations, inpatient days, and outpatient visit-days) for differences in age, sex, diagnosis year, region, insurance plan type, Elixhauser Comorbidity Index), and 60-day prediagnosis costs. Because mortality data were not available, models could not be adjusted for survival times. Among 29,915 patients with a primary diagnosis of AML, 985 patients met inclusion criteria (774 [79%] receiving chemotherapy alone and 211 [21%] alloHCT). Adjusted mean 1-year costs were $280,788 for chemotherapy and $544,178 for alloHCT. Patients receiving chemotherapy alone had a mean of 4 hospitalizations, 52.9 inpatient days, and 52.4 outpatient visits in the year after AML diagnosis; patients receiving alloHCT had 5 hospitalizations, 92.5 inpatient days, and 74.5 outpatient visits. Treating AML in the first year after diagnosis incurs substantial healthcare costs and utilization with chemotherapy alone and with alloHCT. Our analysis informs healthcare providers, policymakers, and payers so they can better understand treatment costs and utilization for privately insured patients aged 50 to 64 with AML.
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
authors.forename: Jaime M
authors.initials: JM
authors.lastname: Preussler
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
authors.forename: Christa L
authors.initials: CL
authors.lastname: Meyer
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
authors.forename: Lih-Wen
authors.initials: LW
authors.lastname: Mau
authors.affiliation: Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Denzen
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
authors.forename: Kristen C
authors.initials: KC
authors.lastname: Edsall
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Farnia
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Burns
authors.affiliation: Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin. Electronic address: dvanness@wisc.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Vanness
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004358:Drug Therapy / Q000191:economics; D005260:Female; D017048:Health Care Costs; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006801:Humans; D007348:Insurance, Health; D015470:Leukemia, Myeloid, Acute / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D014184:Transplantation, Homologous / Q000191:economics; D014481:United States
keywords: Acute myeloid leukemia; Claims data; Cost analysis; Hematopoietic cell transplantation; Resource utilization