Characterization of Health Care Resource Utilization Among Commercially Insured Relapsed Acute Myeloid Leukemia Patients in the United States
Authors: Qian Chunlin , Kwong Jackie 
Published: October 2019

Abstract
Introduction
Relapsed acute myeloid leukemia (AML) patients have poor prognosis and few treatment options. Limited data exists on the economic burden of patients with AML after relapsed from initial therapy. The objective of this study was to assess the health care resource utilization patterns of relapsed AML from US commercial payer perspective.
Methods:
A retrospective analysis was performed using the IQVIA™ Real-World Data Adjudicated Claims - US database. Patients were eligible if they had at least one inpatient claim associated with relapsed AML diagnosis as identified by ICD-9 (205.02) and ICD-10 (C92.02, C92.42, C92.52, C92.62, C92.A2) codes between 1/1/2010 to 9/30/2016, and did not have any inpatient claims associated with relapsed AML diagnosis in the 12 months before index inpatient relapsed AML claim. Inpatient, emergency department (ED) and outpatient health care visits and costs associated with chemotherapy administration, chemotherapy-related toxicity, bone marrow transplant (BMT), and graft versus host disease (GVHD) identified by corresponding procedure codes, ICD-9 or ICD-10 diagnosis codes during the 6 months after index inpatient claim were summarized.
Results:
The study sample consisted of 1,929 patients [47.3% females; 17.4% age ≥ 65 years]. During the 6-month follow-up period, 78.2%, 97.8%, 56.0% and 27.7% patients had medical claims associated with chemotherapy administration, chemotherapy-related toxicity, BMT and GVHD, respectively. Mean (SD) number of hospital admissions per patient was 2.92 (2.02) per patient, with 44.7% hospitalizations associated with chemotherapy administration, 82.5% hospitalizations associated with chemotherapy-related toxicity, 30.2% hospitalizations associated with BMT and 12.8% hospitalizations associated with GVHD diagnosis. Mean (SD) number of outpatient visits was 38.9 (33.2) per patient, with 16.2%, 31.2%, 14.3% and 4.3% of visits related to chemotherapy administration, chemotherapy-related toxicity, BMT and GVHD, respectively. Utilization of ED services was less common [mean (SD)=0.73 (1.78) visit per patient]; they were most often associated with chemotherapy-related toxicity (50.6%) and rarely associated with chemotherapy administration (1.7%), BMT (4.7%) or GVHD (0.9%).
Mean (SD) total medical cost over the 6-month follow-up period was $291,165.37 (284,731.52) per patient, with 45.2% attributed to health care encounters with chemotherapy administration or toxicity without mentioning of BMT/GVHD diagnosis, 42.5% for health care encounters associated with diagnoses of both chemotherapy administration or toxicity and BMT/GVHD, 3.9% for BMT/GVHD without mentioning of chemotherapy administration or toxicity, and 8.4% unrelated to chemotherapy administration/toxicity, BMT or GVHD. Overall, 82.9% of total medical cost was for inpatient services, and 16.9% and 0.21% were for outpatient and ER visits, respectively.
Conclusion:
Inpatient admissions associated with chemotherapy administration and toxicity management represent a significant portion of health care expenditures among relapsed AML patients. Future treatments that simplify the route of administration, reduce the need for hospitalization and toxicity may offer the opportunity to reduce economic burden to the health care system.

Disclosures
Qian: Daiichi Sankyo, Inc.: Employment, Equity Ownership. Kwong:Daiichi Sankyo, Inc.: Employment, Equity Ownership.