Premature Treatment Discontinuation Among Previously Untreated Medicare Beneficiaries With Chronic Lymphocytic Leukemia Treated With Oral Targeted Therapies: A Real-World Analysis
Author(s)
Scott F. Huntington, MD1, Justin T. Puckett, BA2, Dureshahwar Jawaid, MPH3, Beenish S. Manzoor, MPH, PhD3, Sophia S. Li, MPH4, Nnadozie Emechebe, MPH, PhD3, Holly Budlong, PharmD, PhD, BCPS3, Sachin Kamal-Bahl, PhD2, Jalpa A. Doshi, PhD5;
1Yale University, New Haven, CT, USA, 2COVIA Health Solutions, Lansdale, PA, USA, 3AbbVie Inc., North Chicago, IL, USA, 4Genentech Inc., South San Francisco, CA, USA, 5University of Pennsylvania, Philadelphia, PA, USA
1Yale University, New Haven, CT, USA, 2COVIA Health Solutions, Lansdale, PA, USA, 3AbbVie Inc., North Chicago, IL, USA, 4Genentech Inc., South San Francisco, CA, USA, 5University of Pennsylvania, Philadelphia, PA, USA
Presentation Documents
OBJECTIVES: To examine premature treatment discontinuation among patients initiating oral targeted agents, BTKis or BCL2is, for chronic lymphocytic leukemia (CLL) in the frontline setting.
METHODS: This retrospective cohort study used 2016-2022 100% Medicare fee-for-service claims, identifying beneficiaries age ≥66 years initiating ibrutinib (IBR), acalabrutinib (ACA) or venetoclax (VEN) for frontline CLL between 6/1/2019 and 6/30/2021, ensuring a minimum 18-month follow-up for each patient. Discontinuation (i.e., consecutive 90-day gap in treatment) was assessed using the Kaplan-Meier method and considered premature if it occurred within 12 months of treatment initiation of the continuous treat-to-progression BTKis (IBR and ACA) or fixed-duration treatment for VEN (i.e., twelve 28-day cycles). All patients had ≥6 months of follow-up after discontinuation to assess post-discontinuation outcomes (all-cause death, switching to alternative treatment, and healthcare costs). All outcomes were descriptively reported.
RESULTS: In our sample of 3,653 beneficiaries (2,412 IBR; 808 ACA; 433 VEN), premature discontinuation rates were 35.9% (IBR), 29.0% (ACA) and 29.6% (VEN) with median time to discontinuation of 4.0, 5.1 and 6.5 months, respectively. Among premature discontinuers, VEN had a lower rate of all-cause death (26.6%) compared to IBR (31.4%) and ACA (32.5%) over follow-up. Premature VEN discontinuers also had lower rates of switching (<8.6%) compared to IBR (35.3%) and ACA (26.9%). Among IBR switchers, 37.9% and 30.1% switched to another BTKi or VEN; among ACA switchers, 38.1% and 33.3% switched to VEN or chemotherapy. Reasons for discontinuation differed between BTKi and VEN. In the 6-months after discontinuation, all-cause healthcare costs were lower for VEN ($30,452) compared to IBR ($43,315) and ACA ($46,923).
CONCLUSIONS: This real-world analysis found VEN and ACA patients had lower rates of premature discontinuation compared to IBR. VEN patients had lower rates of death, three-to-four times lower rate of treatment switching, and lower healthcare costs compared to ACA and IBR.
METHODS: This retrospective cohort study used 2016-2022 100% Medicare fee-for-service claims, identifying beneficiaries age ≥66 years initiating ibrutinib (IBR), acalabrutinib (ACA) or venetoclax (VEN) for frontline CLL between 6/1/2019 and 6/30/2021, ensuring a minimum 18-month follow-up for each patient. Discontinuation (i.e., consecutive 90-day gap in treatment) was assessed using the Kaplan-Meier method and considered premature if it occurred within 12 months of treatment initiation of the continuous treat-to-progression BTKis (IBR and ACA) or fixed-duration treatment for VEN (i.e., twelve 28-day cycles). All patients had ≥6 months of follow-up after discontinuation to assess post-discontinuation outcomes (all-cause death, switching to alternative treatment, and healthcare costs). All outcomes were descriptively reported.
RESULTS: In our sample of 3,653 beneficiaries (2,412 IBR; 808 ACA; 433 VEN), premature discontinuation rates were 35.9% (IBR), 29.0% (ACA) and 29.6% (VEN) with median time to discontinuation of 4.0, 5.1 and 6.5 months, respectively. Among premature discontinuers, VEN had a lower rate of all-cause death (26.6%) compared to IBR (31.4%) and ACA (32.5%) over follow-up. Premature VEN discontinuers also had lower rates of switching (<8.6%) compared to IBR (35.3%) and ACA (26.9%). Among IBR switchers, 37.9% and 30.1% switched to another BTKi or VEN; among ACA switchers, 38.1% and 33.3% switched to VEN or chemotherapy. Reasons for discontinuation differed between BTKi and VEN. In the 6-months after discontinuation, all-cause healthcare costs were lower for VEN ($30,452) compared to IBR ($43,315) and ACA ($46,923).
CONCLUSIONS: This real-world analysis found VEN and ACA patients had lower rates of premature discontinuation compared to IBR. VEN patients had lower rates of death, three-to-four times lower rate of treatment switching, and lower healthcare costs compared to ACA and IBR.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD51
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology