Journal of Health & Medical Economics

Impact on Cost of Care of Concomitant Prescribing of Acid Reducing Agents with Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia Patients: A US Payer Perspective

Context: Tyrosine Kinase Inhibitors (TKIs) have transformed outcomes for chronic myeloid leukemia patients. However, their bioavailability can be reduced when co-administered with Acid-Reducing-Agents (ARAs) which occur in up to 1 in 2 patients. This may compromise efficacy and increase cost of care.

Objective: We used a US-claims database to assess the cost impact of concomitant use of TKIs with ARAs over 24 months.

Design, setting and participants: The Merative claims database identified patients with a CML code and 6 months data before and 24 months after starting a TKI. These were divided into TKI-Only and TKI-ARA cohorts. Hospitalization, readmission, and ER visit rates were analyzed and the total cost of care computed for the two cohorts over a period of 24 months, entropy balancing was used to adjust for covariates.

Results: 2,630 patients were identified, including 1,913 in TKI-Only (73%) and 712 in TKI-ARA (27%) cohorts. In TKIOnly vs TKI-ARA cohorts, hospitalization rates were 27% vs 39%, readmission rates 14% vs 26%, and ER visit rates 48% vs 59%, respectively. Total Cost of Care Per Patient Per Month (PPPM) for 24 Months was $10,286 in TKI-Only versus $12,950 in TKI-ARA. The respective cost with commercial insurance was $11,353 vs $15,444. In TKI-Only vs TKI-ARA hospitalization, outpatient drug and outpatient procedure PPPM costs were $3,965 vs $6,331, $7,799 vs $8,283, and $1,391 vs $2,176, respectively.

Conclusion: Concomitant use of a TKI and ARA is associated with increased total cost of care in CML. TKI and ARAcomedication was also associated with increased hospital admissions, readmissions within 30 days and increased ER visits.

Author(s): Adrian Kilcoyne

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