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With tyrosine kinase inhibitor (TKI) therapy, chronic myelogenous leukemia (CML) is now a chronic disease. CML patients treated with TKIs (n = 1200) were identified from the OptumLabs® Data Warehouse (de-identified claims and electronic health records) between 2000 and 2016 and compared with a non-cancer cohort (n = 7635). The 5-year cumulative incidence of all organ system outcomes was significantly greater for the TKI versus non-cancer group. In the first year, compared with imatinib, later generation TKIs were associated with primary infections (hazard ratios [HR] 1.43, 95% CI 1.02-2.00), circulatory events (HR 1.15, 95% CI 1.01-1.31), and skin issues (HR 1.43, 95% CI 1.13-1.80); musculoskeletal and nervous system/sensory issues were less common (HRs 0.83-0.84, p

PurposeGiven the widespread introduction of tyrosine kinase inhibitors (TKIs), we evaluated the cost associated with chronic myelogenous leukemia (CML) care compared with the cost of care for patients with hematologic malignancies (HEM) and for patients without cancer (GEN), to aid with resource allocation and clinical decision making.MethodsA retrospective cohort was constructed from the OptumLabs Data Warehouse using claims from 2000 to 2016. Eligible patients had ≥ 2 CML claims and were enrolled continuously for ≥ 6 months before diagnosis and ≥ 1 year afterward (n = 1,909). Patients with CML were frequency matched 4:1 with HEM and GEN cohorts and were observed through October 2017. We used generalized linear models to assess the variation in total mean annualized health care costs in the 3 cohorts and to examine the influence of factors associated with costs.ResultsMean annualized costs for CML were $82,054 (ie, $25,471 [95% CI, $20,808 to $30,133] more than those for HEM and $74,993 [95% CI, $70,818 to $79,167] more than those for GEN); these differences were driven by pharmacy costs in the CML group. The cost of CML care exceeded that for HEM and GEN for all index years in this study and increased over each diagnostic interval until 2015, peaking at $91,990. The mean annual cost of all TKIs increased. Imatinib's mean annualized cost was $41,546 in the period 2000-2004 but increased to $105,069 in the period 2015-2017. In multivariable analysis, percent days on TKIs had the greatest influence on cost: ≥ 75% of the time versus none showed a difference in cost of $108,716 (95% CI, $99,193 to $118,239).ConclusionContemporary CML costs exceeded the cost of treatment of other hematologic malignancies. Cost was primarily driven by TKIs, whose cost continued to increase over time.

Objectives: To investigate treatment patterns and healthcare costs of patients with metastatic colorectal cancer (mCRC) or lung cancer (LC) who were treated with bevacizumab in a physician office (OFF) setting versus a hospital outpatient (HOP) setting., Study Design: Retrospective analysis of claims from a national US health plan., Methods: mCRC and LC patients initiating treatment with bevacizumab (index date) between January 1, 2006, and July 31, 2012, were identified. Patients were aged ≥18 years with ≥6-month pre- (baseline) and ≥6-month post index (follow-up) data, retaining patients who died with <6 months of follow-up. Differences by site of service were analyzed by χ2 and t test (bevacizumab administrations, dose) and general linear model adjusted for demographic and clinical characteristics (all-cause healthcare costs)., Results: A total of 1687 mCRC (OFF: 1292; HOP: 395) and 1232 LC patients (OFF: 983; HOP: 249) were identified. Mean age was 61.3 years, 56.3% were male, and 78% were treated in OFF. Treatment in OFF declined from 2006 (84% of patients) to 2012 (61%). For OFF versus HOP, mean length of treatment (208.3 vs 191.0 days; P=.007), number of bevacizumab administrations per month (1.4 vs 1.1; P<.001), and mean weekly dose (eg, for 2012, 4.34 vs 3.11 mg/kg, P<.05) were higher in OFF. Adjusted monthly HOP costs (vs OFF) were higher by 37.8% for mCRC patients (cost ratio=1.378; 95% CI, 1.282-1.482) and 31.1% for LC patients (cost ratio=1.311; 95% CI, 1.204-1.427) CONCLUSIONS: Despite fewer administrations and lower weekly dose of bevacizumab in HOP, adjusted total costs were 31% to 38% higher for mCRC and LC patients treated in the HOP setting.