OBJECTIVES: This study compared HRU and costs in patients receiving dasatinib or nilotinib as first-line therapy for CML, with a focus on PE-related economic outcomes.

METHODS: Adult patients newly diagnosed with CML who received dasatinib or nilotinib as first-line therapy on/after October 2010 were identified in two large US administrative claims databases (2006-2016). Patients were observed from initiation to completion of first-line tyrosine kinase inhibitor (TKI) therapy. HRU, including inpatient days, healthcare costs (from a payers' perspective; USD 2016) were measured during first-line TKI therapy. All-cause HRU and costs and PE-related costs were compared between dasatinib and nilotinib patients using multivariate regression models. Due to varying therapy duration, results were reported per-patient-per-year (PPPY).

RESULTS: A total of 1,156 dasatinib and 677 nilotinib patients met the sample selection criteria. Mean age was 52 years and 54% were male in both cohorts. Mean first-line TKI therapy duration was 13.6 months for dasatinib and 15.5 months for nilotinib.

On average, the unadjusted number of all-cause inpatient days PPPY was 1.7 for dasatinib patients, where 0.4 (22%) were PE-related; nilotinib patients had 1.2 all-cause inpatient days PPPY, where 0.2 (17%) were PE-related. After adjustment, dasatinib patients had 1.9 times more all-cause inpatient days (adjusted incidence rate ratio [IRR] =1.9; p=.002) and over 3 times more PE-related inpatient days (adjusted IRR=3.2; p=.042) than nilotinib patients.

On average, unadjusted all-cause total cost PPPY was $153,437 for dasatinib patients, where $10,763 was PE-related; all-cause total cost PPPY was $132,726 for nilotinib patients, where $7,518 was PE-related. After adjustment, dasatinib patients incurred higher all-cause total costs by $17,901 PPPY compared to nilotinib patients (adjusted cost difference; p=.004); where $6,048 (34%) of the difference was PE-related (adjusted cost difference; p=.004).

CONCLUSIONS: Dasatinib was associated with higher HRU and healthcare costs, particularly related to pleural effusion, compared to nilotinib.