Treatment patterns and healthcare costs among newly-diagnosed patients with chronic myeloid leukemia receiving dasatinib or nilotinib as first-line therapy in the United States

OBJECTIVE:

To compare treatment patterns and economic outcomes of dasatinib and nilotinib as 1st-line therapies for chronic myeloid leukemia (CML).

METHODS:

Adult CML patients initiated on first-line dasatinib or nilotinib in 2010-2014 were identified from two large US administrative claims databases. Treatment patterns, tyrosine kinase inhibitor (TKI) adherence and healthcare resource utilization (HRU) and costs were measured from the 1st-line TKI initiation (index date) to the end of follow-up.

RESULTS:

A total of 604 and 418 patients were included in the dasatinib and nilotinib cohorts (mean ages = 50.9 and 52.5 years, 46.4% and 45.7% female), respectively. Among the dasatinib patients, 91% started with 100 mg/day, 3% with <100 mg day and 6 with>100 mg/day. Among the nilotinib patients, 76% started with 600 mg/day, 16% with >600 mg/day, and 8% <600 mg day. thedasatinibcohort had a higher hazard of dose decrease hazard ratio hr=" 1.66;" p=" .002)" and of switching to another tki hr="1.62;" p=" .019)" compared to thenilotinibcohort. the hazard of dose increase hr="0.76;" p=" .423)" andtreatmentdiscontinuation hr="1.10;" p=" .372)" were not significantly different between cohorts. there was also no significant difference in tki adherence levels mean proportion of days covered pdc difference over first 6 months="-0.0003," p=" .981;" mean pdc difference over first 12 months="-0.0022," p=" .880)" and hru inpatient day incidence rate ratio irr=" 1.03," p=" .930;" emergency room irr="1.26," p=" .197;" and days with outpatient services irr="1.01," p=" .842)." thedasatinibcohort incurred higherhealthcare costsby 749 per patient per month p=" .044)" compared to thenilotinibcohort.>

LIMITATION:

Information on CML phase and Sokal score was not available.

CONCLUSIONS:

Dasatinib was associated with an increased hazard of dose decrease and switching to another TKI and higher healthcare costs, vs nilotinib.