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Are Newer TKIs Worth the Cost? Closer Look at Financial Burdens of CML

By: Melissa Steele-Ogus
Posted: Friday, December 4, 2020

Imatinib and other tyrosine kinase inhibitors (TKIs) have increased the life expectancy of patients with chronic myeloid leukemia (CML) to such an extent that it is now near that of the general population. Gary H. Lyman, MD, MPH, of the University of Washington, and colleague investigated the financial burden of TKI therapy on patients with CML. “High costs may result in treatment delays, poor compliance, or early termination of effective therapy, leading to poorer outcomes for individuals with a treatable and potentially curable malignancy,” they explained. Results from their analysis were published in a Research Letter in JAMA Oncology.

The authors utilized the OptumLabs Data Warehouse to identify patients with CML between 2010 and 2019. Patients diagnosed at least 6 months prior to receiving treatment with a TKI, including imatinib, dasatinib, nilotinib, bosutinib, or ponatinib, qualified for the study; those who received a stem cell transplant were excluded.

In 2010, 19% of patients (28 of 148) were receiving a second- or third-generation TKI; this number increased to 56% (146 of 263) by 2019. In the first year of treatment, approximately one in four patients switched from the initial TKI. Similarly, there was also an increase in second- or third-generation TKI in the first year of treatment from 2010 to 2018, from 34% (37 of 108) to 64% (137 of 213).

The TKI represented 66% of first-year costs for Medicare Advantage members in 2018 and 65% for enrollees in commercial plans—representing the largest driver of health-care expenditures in patients with CML, they reported. The cost of TKIs increased from $243 to $354 per day over the first 8 years of the study.

“Policies that address rising cancer drug prices and overall health-care expenditures must be of the highest priority for clinicians, payers, patient advocates, and policymakers moving forward,” the authors concluded.

Disclosure: The authors reported no conflict of interest.



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