OBJECTIVES: Chronic lymphocytic leukemia (CLL) is associated with a heavy economic burden. This study aims to evaluate healthcare resource utilization (HCRU) in the changing treatment era of CLL.

METHODS: A retrospective database study was conducted in Maccabi Healthcare Services, a 2.2-million-member health fund in Israel. Included were CLL patients (defined by diagnosis, pharmacy and laboratory data in 1999-2017) initiating treatment in 2009-2017 (index=first line, L1). HCRU was measured annually pre- and post-index (Y_n) through 31/3/2018. Drivers of costs were investigated (per-patient-per-year direct medical costs estimated using Israeli Ministry of Health 2018 data).

RESULTS: Among 411 included patients (mean±SD age: 63.8±11.5y; 63.7% male), 19.5% received L1 fludarabine/rituximab (primarily with cyclophosphamide [FCR]), 12.2% bendamustine/rituximab (BR), 11.4% obinutuzumab±chlorambucil (G-Clb), 22.3% chlorambucil monotherapy (Clb), 27.5% rituximab±chemotherapy not-elsewhere-classified and 7.1% other. Age (mean±SD) was lowest for L1-FCR (58.6±8.0y) and highest for Clb (75.0±8.9y) and G-Clb (74.8±6.9y). In Y₁, 54% were hospitalized (median=9 days [FCR: 52%, median=6 days]) and the median number of outpatient hematologist and primary-care-practitioner visits was 16 (FCR: 23) and 20 (FCR: 17), respectively. From Y₁ to Y₂, there was no observed increase in hospitalization and outpatient visits and the ratio of hospitalization-to-outpatient-visit costs remained similar (1.6 vs. 1.4).

CONCLUSIONS: This real-world study suggests that the economic burden within the first years of CLL treatment initiation is largely driven by hospitalization, similar to European reports.