CML patients treated with dasatinib associated with better treatment adherence, lower health costs: Study

Patients with chronic myeloid leukemia (CML) who were treated with nilotinib are found to be associated with better treatment adherence, less hospitalizations, and lower total health care costs than patients treated with dasatinib, according to a new study released by Analysis Group Inc., a leading provider of health care research and economic consulting.

“This study helps us better understand how these two important drugs are actually being used in the community to treat CML patients. This type of analysis is unique and highly complementary to smaller, controlled clinical studies”

The study, to be published in Current Medical and Research Opinion (CMRO), found that CML patients treated with dasatinib were associated with more than twice as many inpatient days and nearly double the number of inpatient admissions compared to nilotinib patients. Over the study period, dasatinib patients incurred $8,828 more in total medical service costs, and the cost difference was mainly driven by an inpatient cost difference of $8,520. In addition, dasatinib patients were associated with 13% lower adherence to their treatment than patients treated with nilotinib. The updated results of the adherence analysis, including the results of a sensitivity analysis using an alternative measure of adherence, was presented at the Annual American Society of Hematology (ASH) Meeting on December 6, 2010.

The study -- authored by a team of economists and oncologists led by Analysis Group Managing Principal Eric Q. Wu, Ph.D., and Harvard University's Dana Farber Cancer Institute oncologist James D. Griffin, MD -- analyzed patients diagnosed with CML and treated with a second-line tyrosine kinase inhibitor (TKI) in a second-line, real-world setting. Patients were followed for up to six months from the treatment initiation to the end of data availability. Treatment adherence, medical visits (including outpatient visits and hospitalization days), and health care costs were compared between the two TKIs.

"This study is among the first to provide valuable information on real-world treatment outcomes associated with the use of nilotinib and dasatinib," said Dr. Wu. "We hope these findings will contribute to the knowledge base of these two therapies and aid physicians and third-party payers in their treatment and reimbursement decisions."

CML in advanced phase can be a severe and aggressive form of cancer. The National Cancer Institute estimates that almost 5,000 people will be diagnosed with CML in 2010. Although imatinib has been an effective treatment for CML, a significant portion of patients are either intolerant or have developed resistance to imatinib. Thus, the availability of second-line treatments is critical for these individuals. Nilotinib and dasatinib are both approved for treatment in first-line and second-line treatment for CML, but there has been little research on the comparative outcomes of these treatments in a real-world clinical practice setting.

"This study helps us better understand how these two important drugs are actually being used in the community to treat CML patients. This type of analysis is unique and highly complementary to smaller, controlled clinical studies," commented Dr. Griffin, chair of Medical Oncology at Harvard University's Dana Farber Cancer Institute and a co-author of the study. The study was funded by Novartis Pharmaceuticals Corporation.

The researchers used medical and pharmacy claims from the Thomson Reuters MarketScan and Ingenix Impact databases, two of the largest medical claims databases in the U.S, to extract the study sample. These two databases include health insurance information from over 80 million individuals from all regions of the U.S., and are widely used for research of patient outcomes in a real-world setting.

Dr. Wu presented some of the key findings of the study at the 52nd American Society of Hematology (ASH) Annual Meeting and Exposition in Orlando, FL, on December 6, 2010.