In chronic myelogenous leukemia (CML) patients taking a tyrosine kinase inhibitor (TKI), earlier initiation of molecular testing is associated with lower treatment costs and less likelihood of disease progression, according to a case-control study.
“Earlier monitoring may have the potential to reduce the rate of CML progression and lower associated health care resource utilization and costs,” reported Elias Jabbour, MD, an associate professor in the Department of Leukemia at the University of Texas MD Anderson Cancer Center, in Houston. Dr. Jabbour noted that the National Comprehensive Cancer Network (NCCN) recommends monitoring as often as every three months once treatment is started.
Previous studies have shown that as few as 30% of CML patients receive testing in accordance with these guidelines, and as many as 75% of patients do not receive testing within three to six months of starting treatment, according to data that Dr. Jabbour cited.
In this case-control analysis using data from a health care claims database, investigators compared the outcomes of 1,097 patients who received “later” monitoring and 1,633 patients who received “earlier” monitoring. The definitions of early and late monitoring were based on relationship to an index date. The earlier monitoring group had at least one test seven or more months before this index date. The later group was monitored for the first time six months or less before the index date. The age and sex distributions of the two groups were similar.
After adjusting for covariates, the investigators found that health care costs per month were lower for patients monitored earlier than for those monitored later. For example, the differences in inpatient and outpatient costs were about $1,000 less per month for those evaluated earlier (P<0.0001 for both). Outpatient pharmacy costs also were nearly $1,000 less per month (P=0.0024). Total monthly health care costs were about $3,000 less (P<0.0001).
Earlier testing also was associated with better prognosis. “After adjusting for patient characteristics, patients with earlier monitoring were less likely to have CML progression during the follow-up period than patients with later monitoring,” Dr. Jabbour said. The risk reduction was nearly 30% (odds ratio, 0.715; P=0.028).
Dr. Jabbour cautioned that the differences between earlier and later monitoring for costs and outcomes are associations; therefore, a causal relationship cannot be shown. Nevertheless, he suggested that earlier monitoring is consistent with the NCCN guidelines and the potential for clinical benefit and lower costs. He emphasized that waiting to conduct testing only when clinical symptoms are present is not recommended practice.
“As recommended in the NCCN guidelines, early and often molecular testing is crucial in CML patients on TKI therapy,” commented Amanda N. Seddon, PharmD, a clinical pharmacy specialist in hematology/oncology/cellular therapy at Rush University Medical Center, in Chicago. “This retrospective data by Dr. Jabbour provides additional evidence to support the need for early monitoring to detect disease progression. It also highlights the nonadherence to early monitoring that we often see with our patients,” Dr. Seddon told Clinical Oncology News.
In the era of value-based care, Dr. Seddon called these data “meaningful and important,” noting that they “[shed] light on both the clinical and financial impact of early monitoring.”