EE366 Real-World Healthcare Resource Utilization and Cost By Relapse Frequency Among US Patients with Schizophrenia and Schizoaffective Disorder

Objective:A potential complication for all new multiple myeloma (MM) patients is the clinical presentation of osteolytic lesions which increase the risk for skeletal-related events (SREs). However, the contribution of SREs to the overall economic impact of MM is unclear. The impact of SREs on healthcare resource utilization (HCRU) and costs for US patients with MM was analyzed in Truven Health Marketscan Commercial Claims and Medicare Supplemental Databases.Methods:Adults diagnosed with MM between January 1, 2005 and December 31, 2010 with ≥2 claims ≥30 days apart (first claim = index date) were included. SREs included: hypercalcemia, pathologic fracture, surgery for the prevention and treatment of pathologic fractures or spinal cord compression, and radiation for bone pain. Rates of HCRU (outpatient [OP], inpatient [IP], emergency room [ER], orthopedic consultation [OC], and ancillary) and healthcare costs were compared between MM patients with and without SREs. Inverse propensity weighting was applied to adjust for potential bias.Results:Of 1028 MM patients (mean age = 67, standard deviation = 13.2), 596 patients with ≥1 SRE and 432 without SREs were assessed. HCRU rates in IP, ER, and ancillary (p < 0.01) and mean total costs of OP, IP, and ER were significantly higher (p < 0.05) for patients with vs without SREs during follow-up. HCRU rates also increased with SRE frequency (p < 0.05 in OP, IP, ER, OC, and ancillary), as did mean total healthcare costs, except for OC (p < 0.001).Limitations:A broad assessment of pharmacotherapy for the treatment of MM was not an objective of the current study. Bisphosphonate use was evaluated; however, results were descriptively focused on frequency of utilization only and were not included in the broader cost and HCRU analysis.Conclusions:Among US patients with MM, higher SRE frequency was associated with a significant trend of higher HCRU and total healthcare costs in several settings.

Objectives Healthcare resource utilization (HCRU) and cost assessments for generalized myasthenia gravis (gMG) rarely include matched controls. HCRU and costs of acute MG-related events (MG exacerbation and myasthenic crisis) have been examined, but aggregation or comparison between studies is limited by heterogeneity. The study aim was to provide comprehensive, real-world data about gMG patients in the United States, including those experiencing MG-related events. A claims database analysis assessed (i) incremental HCRU and cost burden among adults with gMG versus non-gMG controls, (ii) occurrence of MG-related events, (iii) HCRU and cost burden of MG-related events, and (iv) factors associated with MG-related events. Methods In this retrospective cohort study, adults with gMG in the United States were identified from Optum’s de-identified Clinformatics® Data Mart Database (1 January 2017–31 March 2023). Rates of MG-related events during follow-up were calculated. Regression models assessed associations between occurrence of MG-related events and baseline demographic/clinical variables using a nested case–control design embedded within the existing gMG cohort. Incremental HCRU and healthcare costs were compared between cohorts with/without gMG using the propensity score method with inverse probability of treatment weighting for confounding controls. Incremental HCRU and healthcare costs were also reported for gMG subgroups with/without MG-related events. Results Analyses included 16,561 gMG patients (12,813 prevalent and 3748 incident) and 105,716 non-gMG controls. Among prevalent and incident gMG patients, respectively, MG exacerbation occurred during follow-up in 12.2 and 22.0% and myasthenic crisis in 6.0 and 12.4%. Patients with prior MG-related events were more likely to experience future events (odds ratio range 1.76–7.05). After weighting, gMG patients (median follow-up 696 days) experienced more frequent all-cause HCRU encounters and >4-fold higher healthcare costs ($5420 PPPM or ∼$65,000 per annum) versus non-gMG controls ($1298 PPPM or ∼$15,500 per annum). Among MG patients, those with MG exacerbation/myasthenic crisis, respectively, experienced means of 3.02/3.35 hospitalizations, 1.91/2.13 emergency department encounters, 12.70/13.39 skilled nursing facility encounters, and 67.86/75.52 outpatient encounters during follow-up; associated costs were $17,113/$18,640 PPPM (or ∼$205,000/$224,000 per annum). Conclusion The total healthcare cost of gMG was higher than some previous estimates at $5420 PPPM, driven primarily by inpatient care. MG exacerbation and myasthenic crisis occurred at a notable rate, could be recurrent, and were associated with high HCRU and costs. Findings can inform treatment decision-making with the aim of improving symptom control and reducing the likelihood of MG-related acute events.

Background: Ribociclib, palbociclib, and abemaciclib are cyclin dependent kinase 4 and 6 (CDK4/6) inhibitors for the treatment of women with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced or metastatic breast cancer (mBC). The economic burden of women with HR+/HER2- mBC treated with different CDK4/6 inhibitors has not previously been compared. Objective: To describe and compare healthcare resource utilization (HRU) and healthcare costs in patients treated with CDK4/6 inhibitors in real-world clinical practice. Methods: Adult women with HR+/HER2- advanced or mBC who initiated treatment with ribociclib, palbociclib, or abemaciclib as the first CDK4/6 inhibitor (index therapy) were identified from IBM MarketScan Data (Q1 2000 - Q3 2018), a large US commercial claims database. HRU and healthcare costs were measured while patients were on treatment with their index CDK4/6 inhibitor. Total healthcare costs, measured from a payers' perspective, included medical (inpatient [IP], outpatient [OP], emergency room [ER]) and pharmacy costs, reported per-patient-per-month (PPPM). HRU and healthcare cost components were each separately compared between ribociclib and palbociclib cohorts, and between ribociclib and abemaciclib cohorts, using models adjusting for age, line of therapy, menopausal status, metastatic sites, and comorbidities. Results: A total of 4,320 women were included: 102 initiated ribociclib as first CDK4/6 inhibitor; 4,118 palbociclib; and 100 abemaciclib. The majority in each cohort were postmenopausal (ribociclib: 79%; palbociclib: 92%; abemaciclib: 92%), and received the index CDK4/6 inhibitor as either first-line (ribociclib: 40%; palbociclib: 31%; abemaciclib: 30%) or second-line therapy (ribociclib: 23%; palbociclib: 24%; abemaciclib: 22%). HRU was not statistically different between the ribociclib and palbociclib cohorts, whereas the ribociclib cohort had fewer IP days compared to the abemaciclib cohort (adjusted incidence rate ratio [IRR]: 0.25, 95% CI: 0.09; 0.67). Total healthcare costs were not statistically different between the ribociclib and palbociclib cohorts, although the ribociclib cohort had lower OP costs PPPM compared to the palbociclib cohort (-$1,339, 95% CI: -2,344; -209). Total healthcare costs were statistically lower for the ribociclib cohort compared to the abemaciclib cohort (-$6,519; 95% CI: -9,959; -2,984). IP costs, OP costs, and pharmacy costs (driven by CDK4/6 inhibitor costs) were all significantly lower for the ribociclib cohort vs the abemaciclib cohort (IP: -$3,398, 95% CI: -22,801; -768; OP: -$3,778, 95% CI: -6,502; -1,659; pharmacy costs: -$1,744, 95% CI: -2,881; -564). Conclusions: HRU while on treatment was similar between ribociclib and palbociclib, while ribociclib had fewer IP days compared to abemaciclib, after adjusting for baseline covariates. Total healthcare costs while on treatment were higher in the abemaciclib cohort compared to the ribociclib cohort, while ribociclib and palbociclib cohorts tended to have similar total healthcare costs. Ribociclib vs. PalbociclibRibociclib vs. AbemaciclibHRUAdjusted IRRConfidence intervalP-valAdjusted IRRConfidence intervalP-valIP admissions1.09(0.62; 1.91)0.760.67(0.29; 1.53)0.34IP days0.67(0.35; 1.28)0.220.25(0.09; 0.67)0.01*Days with ER services1.44(0.80; 2.57)0.220.76(0.37; 1.59)0.47Days with OP services1.01(0.91; 1.14)0.800.88(0.73; 1.04)0.14PPPM Healthcare costsAdjusted cost differenceConfidence intervalP-valAdjusted cost differenceConfidence intervalP-valTotal healthcare costs-1,013.82(-3,436; 1,924)0.48-6,519.18(-9,959; -2,984)&amp;lt;0.01*Medical costs-1,222.84(-3,275; 1,231)0.32-6,142.36(-9,907; -2,844)&amp;lt;0.01*IP costs-279.61(-1,516; 1,749)0.76-3,397.88(-22,801; -768)0.01*ER costs481.32(-87; 1,503)0.19577.82(-105; 2,449)0.16OP costs-1,338.92(-2,344; -209)0.03*-3,778.20(-6,502; -1,659)&amp;lt;0.01*Total pharmacy costs-28.95(-798; 917)0.91-1,743.98(-2,881; -564)&amp;lt;0.01*CDK4/6 costs120.08(-592; 1,053)0.83-1,631.39(-2,755; -464)0.01* Citation Format: Sanjeev Balu, Rebecca Burne, Annie Guerin, Rebecca Bungay, Mary Lisha Paul, Roxana Sin. Comparison of healthcare resource utilization and costs in women with HR+/HER2- metastatic breast cancer treated with ribociclib vs palbociclib or abemaciclib [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-29.

Aim To assess the real-world healthcare resource utilization (HRU) and costs of patients with non-valvular atrial fibrillation (NVAF) and obesity newly initiated on rivaroxaban or warfarin in the US. Methods This retrospective study used IQVIA PharMetrics Plus data (01/2010–09/2019) to evaluate patients (≥18 years) with NVAF and obesity (body mass index ≥30 kg/m2) initiated on rivaroxaban or warfarin (on or after 01/2013). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding between cohorts. HRU and costs were assessed post-treatment initiation. Weighted cohorts were compared using Poisson regression models and cost differences, with 95% confidence intervals (CIs) and p values generated using non-parametric bootstrap procedures. Results After IPTW, 10,555 and 5,080 patients were initiated on rivaroxaban and warfarin, respectively (mean age: 59 years). At 12 months follow-up, the rivaroxaban cohort had lower all-cause HRU, including fewer hospitalizations (rate ratio [RR]: 0.80, 95% CI: 0.74, 0.87), emergency room visits (RR: 0.89, 95% CI: 0.83, 0.97), and outpatient visits (RR: 0.72, 95% CI: 0.69, 0.77; all p < .05). Medical costs were also reduced in the rivaroxaban cohort (mean difference: −$6,759, 95% CI: −$9,814, −$3,311) due to reduced hospitalization costs (mean difference: −$5,967, 95% CI: −$8,721, −$3,327), resulting in lower total all-cause healthcare costs compared to the warfarin cohort (mean difference: −$4,579, 95% CI: −$7,609, −$1,052; all p < .05). The rivaroxaban cohort also had lower NVAF-related HRU and medical costs driven by lower hospitalization at 12 months post-treatment initiation. HRU and cost reductions associated with rivaroxaban persisted up to 36 months of follow-up. Limitations Claims data may have contained inaccuracies and obesity was classified based on ICD diagnosis codes given that patient BMI values were not available. Conclusions Rivaroxaban was associated with reduced HRU and costs compared to warfarin among NVAF patients with obesity in a real-world US setting.

Resource utilization and costs in Cushing's disease (CD) patients have not been studied extensively. We compared CD patients with diabetes mellitus (DM) patients and population-based controls to characterize differences in utilization and costs. Using 2008-2012 MarketScan® database, we identified three patient groups: (1) CD patients; (2) DM patients; and (3) population-based control patients without CD. DM and control patients were matched to CD patients by age, gender, region, and review year in a 2:1 ratio. Outcomes included annual healthcare resource utilization and costs. There were 1852 CD patients, 3704 DM patients and 3704 controls. Mean age was 42.9 years; 78.2 % were female. CD patients were hospitalized more frequently (19.3 %) than DM patients (11.0 %, p < .001) or controls (5.6 %, p < .001). CD patients visited the ED more frequently (25.4 %) than DM patients (21.1 %, p < .001) or controls (14.3 %, p < .001). CD patients had more office visits than DM patients (19.1 vs. 10.7, p < .001) or controls (7.1, p < .001). CD patients on average filled more prescriptions than DM patients (51.7 vs. 42.7, p < .001) or controls (20.5, p < .001). Mean total healthcare costs for CD patients were $26,269 versus $12,282 for DM patients (p < .001) and $5869 for controls (p < .001). CD patients had significantly higher annual rates of healthcare resource utilization compared to matched DM patients and population controls without CD. CD patient costs were double DM costs and quadruple control costs. This study puts into context the additional burdens of CD over DM, a common, chronic endocrine condition affecting multiple organ systems, and population controls.

e19408 Background: Ibrutinib is a targeted oral therapy indicated for MCL patients who received ≥1 prior line of therapy (LOT) (conditional approval on 11/13/2013 in the US). This study compared healthcare resource utilization (HRU) and costs of R/R MCL patients treated with ibrutinib ± rituximab (I±R) or CIT in a US-managed care population. Methods: Optum Clinformatics Extended DataMart De-Identified Databases (05/13/2013-6/30/2019) were used to identify adults with MCL receiving I±R or CIT (index date) following ≥1 prior LOT. Patients’ baseline characteristics were balanced using inverse probability of treatment weighting (IPTW). Monthly HRU and costs (plan paid amount) were evaluated during the first Oncology Care Model (OCM) episode (i.e., first 6 months) post-index and during the observed index I±R or CIT LOT (index LOT); and compared using rate ratios (RRs) and mean monthly cost differences (MMCDs), respectively. Results: A total of 146 I±R and 158 CIT patients were identified. Given the small sample size and to ensure outliers were not driving the results, 2 patients with total healthcare costs ≤0.5th and ≥99.5th percentile were excluded from each cohort. After IPTW, 149 and 151 patients were included in the weighted I±R and CIT cohorts, respectively (mean length of index LOT: 12.0 vs 11.0 months). During the first OCM episode and during the index LOT, the I±R cohort had significantly fewer monthly days with outpatient services compared to the CIT cohort (OCM: RR= 0.63, P&lt;0.001; index LOT: RR= 0.73, P=0.004). The I±R cohort incurred significantly higher monthly pharmacy costs that were offset by lower monthly medical costs, yielding a monthly total cost reduction of $9,435 (p&lt;0.001) during the first OCM episode and $4,628 (p=0.010) during the index LOT, compared to the CIT cohort (Table). Conclusions: In this study, patients with R/R MCL treated with ibrutinib ± rituximab had significantly fewer days with outpatient services and lower total healthcare costs per month versus those treated with CIT during the first OCM episode and the index LOT. [Table: see text]

Background: The Host Immune Classifier is a proteomic test that identifies a chronic inflammatory disease state for patients diagnosed with NSCLC. The test stratifies patients into two groups, HIC-H and HIC-C and helps evaluate patient prognosis and response to treatment. While much work has been done to evaluate the clinical validity of the HIC test, to date, no recent real-world studies have described healthcare resource utilization (HCRU) and costs amongst patients utilizing the test. This subset analysis of HIC claims examined demographic and baseline clinical characteristics among patients with lung cancer using the HIC proteomic test as well as HCRU and costs prior to test use. Methods: This retrospective claims analysis utilized MarketScan® Commercial and Medicare Supplemental Databases using data from January 1, 2016 to June 30, 2021 linked to Biodesix data files of HIC test results. Patients were age 18 or older on index date (date of HIC testing), underwent a HIC proteomic test, were continuously enrolled in the MarketScan database for the 6-months before index (pre-index period), and had at least one non-diagnostic medical claim of lung cancer during the pre-index period. Clinical characteristics and HCRU and costs were measured per patient per month (PPPM) during the pre-index period and compared between HIC-H and HIC-C cohorts. Results: Of the 328 included patients, 260 patients were HIC-H and 68 were HIC-C. On index, 178 patients had non-metastatic lung cancer and 150 patients had metastatic lung cancer. When assessing lung cancer related comorbid conditions, significantly more HIC-C patients had empyema (3% vs 0%, P&amp;lt;0.05) and pneumonia (34% vs 19%, P&amp;lt;0.05). When examining HCRU in patients prior to the HIC test, significantly more HIC-C patients had an outpatient visit with an oncologist (40% vs 27%, P&amp;lt;0.05) or a primary care physician (71% vs 56%, P&amp;lt;0.05). Total costs and inpatient costs were higher amongst HIC-C patients ($10,299 vs $9,689 and $4,032 vs $3,218, respectively) although not significant. While fewer HIC-C patients underwent lung biopsy (41% vs 53%), HIC-C patients had significantly higher biopsy costs than HIC-H patients ($1,285 vs $400, P&amp;lt;0.05). Although not statistically significant, more HIC-C patients had an inpatient admission (47% vs 38%) and longer average length of stay (5.3 vs 4.2 days). Conclusion: Patients with NSCLC who are identified as HIC-C have higher HCRU and costs, including lung cancer workup costs, prior to HIC testing. Further analyses are planned to determine long-term clinical outcomes, HCRU, and costs amongst patients post-testing. Citation Format: Wade Iams, Kimberly Le, Nicole Princic, Isabelle Winer, Taylor Marlin. Real-world demographics, baseline characteristics, healthcare resource utilization and costs amongst non-small cell lung cancer (NSCLC) patients tested with a Host Immune Classifier (HIC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 942.

Aim:To evaluate all-cause and liver-associated healthcare resource utilization (HCRU) and costs among patients with alpha-1 antitrypsin deficiency (AATD) with liver disease (LD) and/or lung disease (LgD).Materials & methods:This was a retrospective analysis of linked administrative claims data from the IQVIA PharMetrics® Plus and the IQVIA Ambulatory Electronic Medical Records (AEMR) databases from 1 July 2021 to 31 January 2022. Patients with AATD in the IQVIA PharMetrics Plus database were included with ≥1 inpatient or ≥2 outpatient medical claims ≥90 days apart with a diagnosis of AATD, or with records indicating a protease inhibitor (Pi)*ZZ/Pi*MZ genotype in the IQVIA AEMR database with linkage to IQVIA PharMetrics Plus. For a patient's identified continuous enrollment period, patient time was assigned to health states based on the initial encounter with an LD/LgD diagnosis. A unique index date was defined for each health state, and HCRU and costs were calculated per person-year (PPY).Results:Overall, 5136 adult and pediatric patients from the IQVIA PharMetrics Plus and IQVIA AEMR databases were analyzed. All-cause and liver-associated HCRU and costs were substantially higher following onset of LD/LgD. All-cause cost PPY ranged from US $11,877 in the absence of either LD/LgD to US $74,015 in the presence of both LD and LgD. Among liver transplant recipients in the AATD with LD health state, liver-associated total costs PPY were US $87,329 1-year pre-transplantation and US $461,752 1-year post-transplantation. In the AATD with LgD and AATD with LD and LgD health states, patients who received augmentation therapy were associated with higher all-cause total costs PPY and lower liver-associated total costs PPY than their counterparts who did not receive augmentation therapy.Conclusion:Patients with AATD had increased HCRU and healthcare costs in the presence of LD and/or LgD. HCRU and healthcare costs were highest in the AATD with LD and LgD health state.

The introduction and widespread use of effective and well-tolerated tyrosine kinase inhibitors for chronic myeloid leukemia have been associated with marked increments in life expectancy and disease prevalence. These changes have been accompanied by elevations in costs of tyrosine kinase inhibitors, which typically must be taken ad vitam after diagnosis and tend to be more expensive than medical therapies for many other hematologic malignancies. The aims of this review included evaluating the potential associations and consequences of healthcare resource utilization and costs of tyrosine kinase inhibitors and possible clinical management approaches to mitigate them. A PubMed search of English-language US study reports was conducted that covered the interval of 2001 (US approval of imatinib) through 17 April, 2023 augmented by manual reviews of published bibliographies from the referenced articles and searches of other databases: Google Scholar and Scopus. On the basis of this analysis of chiefly real-world evidence (administrative claims database studies), healthcare resource utilization and costs can be considered indicators of ineffective chronic myeloid leukemia management, including potentially mutation-driven treatment resistance and costly tyrosine kinase inhibitor switches, non-adherence, and suboptimal tolerability, which may culminate in the progression of disease from the chronic to an accelerated or blast phase, with additional excess costs. Costs of tyrosine kinase inhibitors are also associated with reduced treatment adherence. At a willingness-to-pay threshold of $50,000-$200,000 per quality-adjusted life-year, tyrosine kinase inhibitors can be considered cost effective from a US payer perspective. Potential clinical approaches to mitigate costs include regular molecular monitoring with proactive assessments of BCR::ABL1 gene mutations to avoid costly treatment switches, as well as interventions to enhance treatment adherence and tyrosine kinase inhibitor tolerability. Healthcare resource utilization and costs of chronic myeloid leukemia care may be considered barometers of ineffective management, including mutation-driven tyrosine kinase inhibitor resistance and switching as well as non-adherence and intolerance. Future prospective research is warranted to help determine whether costs can be reduced and other treatment outcomes optimized via more proactive and effective diagnostic interventions (i.e., regular molecular monitoring and proactive mutational testing) and treatment approaches. The strengths and limitations of this review include its emphasis on observational research, which, on one hand, offers a naturalistic "real-world" perspective on current chronic myeloid leukemia management, but, on the other hand, is associational in nature and cannot be used to determine causality and/or its direction.

Aims To assess the real-world healthcare resource utilization (HRU) and costs associated with different proteasome inhibitors (PIs) for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM) in Germany. Methods We conducted a retrospective medical chart review of treatment patterns, outcomes, and HRU for patients with RRMM treated with bortezomib, carfilzomib, or ixazomib in second- or third-line (2L or 3L) therapy in Germany. Data were collected between 1 January 2017 and 30 June 2017. Costs were calculated based on drug prices and unit costs in Germany. Results Physicians provided data on 302 patients. Mean monthly total direct costs per patient receiving PI-based therapy were €7,925 and €10,693 for 2L and 3L, respectively, of which approximately 90% was anti-myeloma drug costs. Overall, the highest costs were associated with patients receiving 3L therapy. Regardless of treatment line, costs were higher for patients who had received a stem cell transplant (SCT) in a previous treatment line than for those who had not; the data suggest that this reflects the use of triplet regimens following a SCT. Patients with a complete response (CR) experienced no unplanned hospitalizations during the study period, whereas patients with progressive disease experienced the highest number of unplanned and planned hospitalizations. In 2L therapy, the highest proportion of patients with a CR was observed in those receiving carfilzomib (12% carfilzomib; 4% bortezomib; 0% ixazomib). Limitations Patients with missing or incomplete follow-up data were included in the study and were accounted for using monthly cost estimates. Conclusions Anti-myeloma drugs were the main contributor to total HRU costs associated with RRMM in Germany. Improved treatment response was associated with lower costs and reduced hospitalizations.

We evaluated the real-world healthcare resource utilization (HRU) and costs among patients with high-grade non-muscle invasive bladder cancer (HG-NMIBC) following Bacillus Calmette-Guérin (BCG) therapy. Patients aged≥65years diagnosed with HG-NMIBC between 2008 and 2015 who received adequate BCG induction and were identified in the SEER-Medicare database. Those who received intravesical chemotherapy or radical cystectomy within 12months of the last BCG induction dose, and had≥6months of data availability after treatment (index date), were included. Annualized HRU and mean medical costs (2020 United States dollars) were estimated and compared between patients with versus without progression. Inverse probability of treatment weighting was used to adjust for differences in baseline characteristics. Of 986 patients diagnosed with HG-NMIBC who met the inclusion criteria, 257 (26.1%) progressed; the mean ages were similar between patients who did and did not progress (77.6 vs. 77.0years). The overall population had a mean of 0.96 [standard deviation (SD): 1.18] inpatient admissions, 6.47 (11.40) hospitalization days, 1.38 (2.19) emergency department (ED) visits, and 48.03 (44.97) outpatient visits per patient-year during the study period; total annualized costs per patient post-BCG were $39,102 ($44,244). Patients experiencing progression had significantly higher mean numbers of inpatient admissions [1.61 (SD 1.40) vs. 0.72 (0.99)], hospitalization days [11.77 (14.96) vs. 4.59 (9.29)], ED visits [2.34 (2.92) vs. 1.03 (1.76)], and outpatient visits [65.97 (44.72) vs. 41.63 (43.09)] per patient-year compared with patients without progression (all p<0.05). Total mean annualized costs per patient after BCG among those who progressed [$65,668 (SD $53,943)] were more than double compared with patients who did not [$29,780 ($36,425)]. Existing treatments for HG-NMIBC after BCG therapy are associated with substantial HRU and medical costs, particularly after progression. Novel treatments and earlier detection are needed to reduce progression rates and associated costs in this difficult-to-treat population.

PMH22 IS INCREASED SEVERITY STATUS ASSOCIATED WITH INCREMENTAL ECONOMIC BURDEN IN PRIVATELY INSURED US PATIENTS WITH TREATMENT RESISTANT DEPRESSION?

Regional Differences in Patient-Reported Outcomes in a Study of Adult Prophylaxis Versus on-Demand Treatment with Bayer’s Sucrose-Formulated Recombinant Factor VIII: 3-Year Data from Spinart

Aim:Given the limited availability of real world diffuse large B-cell lymphoma (DLBCL) data in Germany, we assessed the baseline characteristics, treatments, clinical complications, healthcare resource utilization and costs of DLBCL across treatment lines using German claims data.Materials & methods:In a retrospective cohort study using claims data from a German sickness fund (AOK PLUS), we identified patients with an incident DLBCL diagnosis between 2012 and 2022. Using an algorithm based on German treatment guidelines, patients were stratified into first (1L), second (2L) and third line (3L) treatment. We then descriptively analyzed baseline characteristics, treatments, clinical complications, healthcare resource utilization and costs.Results:A total of 2423 patients with DLBCL and 1L treatment were included in the study (49.1% female; mean age: 69.7 years; mean CCI: 7.0; median follow-up: 29.3 months). A total of 1209 (49.7%) and 505 (20.8%) patients progressed to 2L and 3L, respectively. A total of 209 patients received a stem cell transplant (SCT; mean age: 56.1 years); 37 received a chimeric antigen receptor T-cell therapy (CAR-T; mean age: 60.8 years). Most patients had at least one DLBCL related hospitalization during follow-up (1L: 79.2%; 2L: 60.0%; 3L: 71.9%; mean length of stay [days/patient year]: 1L: 15.2; 2L: 6.4; 3L: 14.2), with corresponding hospitalization costs of 12,777€ (1L), 5993€ (2L) and 17,408€ (3L) per patient year. Clinical complications were common, particularly in 3L, including neutropenia (1L: 31.9%; 2L: 27.0%; 3L: 46.9%), pneumonia (1L: 19.6%; 2L: 16.8%; 3L: 30.3%), anemia (1L: 17.8%; 2L: 18.7%; 3L: 35.2%), thrombocytopenia (1L: 17.3%; 2L: 21.8%; 3L: 45.1%) and sepsis (1L: 14.6%; 2L: 13.0%; 3L: 23.2%).Conclusion:The high proportion of patients with second or later-line treatment (indicating a relapse or refractory disease), the low number of SCTs together with many clinical complications and healthcare resource use underscore the need for novel effective and well-tolerated DLBCL treatment options.

Purpose: This study aimed to evaluate the healthcare resource utilization (HCRU) and costs for patients with severe aplastic anemia (SAA) using US claims data.Methods: This retrospective, observational database study analyzed claims data from the Truven MarketScan databases. SAA patients aged ≥2 years identified between 2014 and 2017 who were continuously enrolled for 6 months before their first SAA treatment or blood transfusion, with a ≥6-month follow-up, were included. Baseline demographics and comorbidities were evaluated. Monthly all-cause and SAA-related HCRU and direct costs in the follow-up period were analyzed and differences were presented for all patients and across age groups.Results: With an average follow-up period of 21.5 months, 939 patients were included in the study. Monthly all-cause and SAA-related HCRU [mean (SD)] were 1.65 days (2.61 days) and 0.18 days (0.70 days) for length of stay, 0.18 (0.23) and 0.01 (0.04) for hospital admissions, 0.25 (0.30) and 0.02 (0.07) for ER visits, 2.24 (1.40) and 0.46 (0.99) for office visits, and 2.90 (2.64) and 0.55 (1.31) for outpatient visits, respectively. On average, SAA patients received 0.15 (0.57) blood transfusions per month. Mean monthly all-cause direct costs were $28,280 USD ($36,127) [US dollars, mean (SD)]. Direct costs related to admissions were $11,433 USD (SD $25,040), followed by $624 USD ($1,703) for ER visits, $528 USD ($694) for office visits, $7,615 USD ($13,273) for outpatient visits, and $5,998 USD ($11,461) for pharmacy expenses. Monthly SAA-related direct costs averaged $7,884 USD (SD $16,254); of these costs, $1,608 USD ($7,774) were from admissions, $47 USD ($257) from ER visits, $127 USD ($374) from office visits, $1,462 USD ($4,994) from outpatient visits, and $4,451 USD ($10,552) from pharmacy expenses.Conclusion: SAA is associated with high economic burden, with costs comparable to blood malignancies, implying that US health plans should consider appropriately managing SAA while constraining the total healthcare costs when making formulary decisions.