OBJECTIVES: Novel agent treatments (NATs) have improved survival in chronic lymphocytic leukemia (CLL), but can be associated with increased cardiovascular (CV) events. This analysis examined real-world healthcare costs associated with CV events in CLL patients treated with NATs.

METHODS: Using US-commercial administrative claims data (IBM MarketScan), we compared unadjusted healthcare costs among CLL patients taking NATs with and without a CV event during treatment (CV vs. noCV). Inclusion criteria were adult CLL patients, evidence of NATs (acalabrutinib, duvelisib, ibrutinib, idelalisib, venetoclax) between November 2013-November 2019 (index date=earliest fill date), continuous enrollment for 6-months pre-index (baseline), and no evidence of NATs or trial participation during baseline. Annual all-cause and CV-related healthcare costs (adjusted to 2019 US dollars) were measured in a fixed 12-month follow-up period while per-patient-per-month (PPPM) costs were compared in variable-length pre/post-CV event periods.

RESULTS: Of 1,886 CLL patients with NATs, 27.7% experienced a CV event during treatment, occurring a mean(SD) 103.0(93.9) days following NAT initiation. Almost half (47.1%) of CV patients had a CV event pre-index, the majority of which were hypertension. CV patients were older (71.7 vs. 65.8, p<0.001) and had a higher baseline NCI score (1.2 vs. 0.8, p<0.001) than noCV patients. Annual all-cause total healthcare costs were higher in the CV vs. noCV cohort ($203,349 vs. $165,144, p<0.001). Higher annual medical costs ($82,949 vs. $45,293, p<0.001) compensated for numerically lower NAT costs in CV vs. noCV cohort ($110,925 vs. $115,026, p=0.262). Pre-CV event, outpatient pharmacy PPPM costs contributed most to total healthcare costs; post-CV event, PPPM medical costs contributed more: outpatient pharmacy 74.8% vs. 38.8%, hospitalization 7.6% vs. 38.8%, and outpatient services 17.7% vs. 22.4%.

CONCLUSIONS: In CLL patients with a CV event, higher medical costs compensate for decreased novel agent costs, suggesting increased medical management in addition to NAT discontinuation.