J Clin Outcomes Manage
Costs and utilization associated with imatinib adherence in patients with chronic myeloid leukemia or gastrointestinal stromal turmors
Halpern R, Barghout V, Zarotsky V, Williams DE
Abstract Objective: To analyze the relationship between imatinib compliance and costs and inpatient hospitalizations for patients with chronic myeloid leukemia (CML) or gastrointestinal stromal tumors (GIST). Design: Administrative claims–based retrospective cohort study. Setting and participants: Patients in a large national U.S. health plan with CML or GIST, 2 or more imatinib claims from 1 June 2001 to 31 March 2005, and a minimum 12-month follow-up after first imatinib claim. Main outcome measures: Adherence to medication (as measured by medication possession ratio) and association with Charlson Comorbidity Index score, total follow-up medical and health care (medical plus pharmacy) costs, inpatient hospitalizations, and length of stay (LOS). Results: 374 CML and 91 GIST patients were identified. Unadjusted mean medical costs and inpatient LOS were significantly and inversely associated with adherence level. Unadjusted total health care costs were inversely related to adherence within the CML cohort. Multivariate analysis showed that good adherence to imatinib, on average, was associated with $121,247 lower medical costs, $57,266 lower health care costs, 31.3 times fewer inpatient hospitalizations, and 9.1 times shorter LOS as compared with poor adherence. Patients with GIST (vs. CML) and those with higher Charlson Comorbidity Index scores had significantly higher medical and health care costs. Conclusion: Good adherence to imatinib was associated with substantially lower follow-up medical and health care costs relative to poor adherence, controlling for condition (ie, CML or GIST) and demographic and health factors.
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