Economic Burden in Patients With Chronic Myeloid Leukemia in Early Lines of Therapy: A Literature Review

OBJECTIVES: Despite various treatment options for early-line chronic phase chronic myeloid leukemia (CP-CML), disease burden remains significant due to chronic treatment requirements, adverse events (AEs), and resistance/intolerance leading to treatment switching. This literature review was conducted to understand further the economic burden in patients with CP-CML.

METHODS: Embase^®, MEDLINE^® and relevant conference-proceedings were searched for English language publications until June 16, 2023. Ex-US studies evaluating costs and/or healthcare-resource-utilization (HCRU) by CP-CML patients were included.

RESULTS: Fifteen studies reported economic burden for CP-CML patients across various treatment lines, majorly from European countries (n=9), followed by Brazil (n=3).

Studies from Italy reported annual direct costs for first-line therapy during 2018-2019 of €20,042, primarily contributed by treatment (€16,517). Notably, hospitalization costs were more for patients with lower adherence compared to those with higher adherence to treatment (€3,567 vs €554). In second-line therapy during 2015-2018 (excluding TKI costs) ponatinib treated patients had the highest mean annual costs/patient (€12,068), significantly influenced by comorbidity-related hospitalizations, followed by bosutinib (€6,196), dasatinib (€5,098), nilotinib (€4,899), and imatinib (€3,837).

In Germany, patients undergoing multiple lines of therapy incurred a mean annual cost of €58,230, primarily driven by the costs of treatment, inpatient services, and outpatient treatment.

In France, disease/treatment-related AEs led to ‘work-absence’, implying an indirect economic burden for 65.2% of patients.

HCRU, including hospitalization, length of stay, and inpatient days varied across different lines of therapy and was higher for patients on nilotinib compared to dasatinib in first-line. In the second-line, HCRU was dominated by hospitalizations, all-cause visits, and drug prescriptions.

CONCLUSIONS: The economic burden in CML patients increases with the line of therapy due to treatment cost, hospitalizations. Hence, the development of efficacious treatment with better safety profile is crucial to address the economic burden in patients with CP-CML.