Health care resource utilization and costs in patients with acute myeloid leukemia treated with posttransplant...

Allogeneic hematopoietic cell transplantation (allo-HCT) improves survival in patients with acute myeloid leukemia (AML); however, posttransplant relapse remains the most common cause of treatment failure and death. Limited data exist on posttransplant health care resource utilization (HCRU) and costs, particularly for patients initiating maintenance therapy.

To describe HCRU and costs among commercially insured patients, Medicaid enrollees from participating US states, and Medicare-eligible beneficiaries with employer-sponsored supplemental coverage who received maintenance therapy after allo-HCT compared with those receiving allo-HCT alone.

We conducted a retrospective cohort study of patients with AML who underwent allo-HCT using claims data from the Merative MarketScan database from October 1, 2015, to March 31, 2024. Patients receiving maintenance therapy were identified by a claim for 1 of the following agents after allo-HCT: azacitidine, decitabine, enasidenib, gemtuzumab ozogamicin, gilteritinib, glasdegib, ivosidenib, midostaurin, quizartinib, sorafenib, or venetoclax. Groups were balanced using inverse probability treatment weighting (IPTW) based on baseline characteristics. We assessed differences in all-cause monthly HCRU and costs. HCRU included emergency department (ED) visits, inpatient (IP) admissions, outpatient (OP) visits, and hospital length of stay throughout the 12-month follow-up period. Poisson and negative binomial regression models estimated event rates. Per patient per month mean costs were reported with SEs, and between-group differences were assessed using mean differences, bootstrapped 95% CIs, and P values. Cumulative costs were summarized using the mean with bootstrapped 95% CIs and the median. IPTW-weighted mean monthly costs were also calculated for each cohort. Transfusion burden was also evaluated.

Of the 373 patients who met the inclusion criteria, 43 were prescribed maintenance therapy following allo-HCT. The maintenance therapy group demonstrated significantly higher HCRU across service types. Both office (incidence rate ratio [IRR] = 3.23, P = 0.004) and OP visits (IRR = 4.26, P < 0.001) were more than tripled compared with the allo-HCT-only group, and IP admissions rose by 34% (IRR = 1.34, P = 0.034). Specialist clinic and ED visit rates were higher but not statistically significant (IRR = 3.03, P = 0.060 and IRR = 1.51, P = 0.483, respectively). Health care costs transitioned from predominantly IP at transplant to mostly pharmacy-driven by month 4, with similar trends across both groups. The maintenance therapy group had significantly higher per patient per month pharmacy costs ($6,433.81 vs $3,132.51, P = 0.002). Blood transfusion requirements were minimal in both groups. Weighted mean length of stay was significantly longer in the allo-HCT-only cohort compared with the maintenance therapy group (26.53 [SE = 1.29] vs 21.40 [SE = 1.21] days, respectively), with a mean difference of -5.13 days (95% CI = -8.60 to -1.65; P = 0.004).

Those who received maintenance therapy following allo-HCT had higher IP admission and OP use rates and incurred more pharmacy costs. These findings highlight the need to balance the clinical benefits of maintenance therapy with its increased demands on health care resources.