OBJECTIVES : Hairy cell leukemia (HCL) is a rare, chronic B-cell malignancy that is currently incurable. Evaluating healthcare utilization and costs is important to understand the overall burden of HCL. This study examined the significant predictors of healthcare utilization and the economic burden among HCL patients in the US Veterans Health Administration (VHA) population.

METHODS : Adult patients with ≥1 diagnosis for HCL during the identification period (01OCT2014-30SEP2017) were included from the VHA population. The first HCL diagnosis was designated as the index date. Continuous enrollment in the VHA system for 12 months pre- and post- (follow-up) index date was required. Patients without a HCL diagnosis but with the same age, sex, race, and index year as a HCL patient were identified as controls. Healthcare utilization and costs during the follow-up period were compared among HCL and control patients. Logistic regression was used to identify predictors of hospitalization (covariates included age [ref: ≥65 years], race [ref: African American], Charlson comorbidity index [CCI] score) among HCL patients.

RESULTS : A total of 1,011 patients were included in each cohort, and the mean age was 74 years. HCL patients had higher mean CCI scores (2.19 vs 1.24; p<0.001) than control patients. During follow-up, more than a five times higher proportion of HCL patients had ≥1 hospitalization (10.1% vs 2.2%; p<0.001). Higher CCI score (OR: 1.17, 95% CI: 1.06-1.28), age (55-64 years: OR: 1.81; 95% CI: 1.08-3.02) were significant predictors of hospitalization among HCL case patients. HCL patients incurred significantly higher inpatient ($3,394 vs $635), outpatient ($4,842 vs $2268), pharmacy ($1,515 vs $505), and total healthcare costs ($9,752 vs $3,408) compared to controls.

CONCLUSIONS : Patients diagnosed with HCL had significantly higher economic burden and healthcare utilization than controls during a 12-month follow-up period. Higher CCI score and age were significant predictors of hospitalization.