{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:48:32Z","timestamp":1784177312791,"version":"3.55.0"},"reference-count":31,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:00:00Z","timestamp":1616025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Information on overall survival (OS) and adverse events (AEs) in patients with chronic lymphocytic leukemia (CLL) is mostly available from clinical trials. We therefore conducted a population\u2010based retrospective cohort study to assess OS, incidence of AEs, and economic burden in real\u2010world practice among Medicare patients treated for CLL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with CLL receiving \u22651 systemic therapy from 2013 to 2015 were selected from the Medicare claims database and followed from the start of first observed systemic therapy (index date) through December 2016 or death. OS for patients receiving each of the most commonly observed treatments was estimated by the Kaplan\u2013Meier method. AEs were assessed among patients receiving these treatments across all observed lines of therapy. All\u2010cause direct medical costs were assessed from the Medicare system perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 7,965 eligible patients across all observed therapy lines, ibrutinib monotherapy (Ibr; <jats:italic>n<\/jats:italic>\u00a0=\u00a02,708), chlorambucil monotherapy (Clb; <jats:italic>n<\/jats:italic>\u00a0=\u00a01,620), and bendamustine\/rituximab (BR; <jats:italic>n<\/jats:italic>\u00a0=\u00a01,485) were the most common treatments. For first observed therapy, 24\u2010month OS estimates for Ibr, Clb, and BR recipients were 69% (95% CI\u00a0=\u00a068%\u201371%), 68% (95% CI\u00a0=\u00a065%\u201371%), and 79% (95% CI\u00a0=\u00a077%\u201381%) respectively. The most frequently recorded AEs in patients receiving these treatments in any observed line of therapy were neutropenia, hypertension, anemia, and infection. For all patients, the mean monthly all\u2010cause cost during the follow\u2010up period was $8,974 (SD\u00a0=\u00a0$11,562); cost increased by the number of AEs, from $5,144 (SD\u00a0=\u00a0$5,409) among those with 1\u20132 AEs to $10,077 (SD\u00a0=\u00a0$12,542) among those with \u22656 AEs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Over two\u2010thirds of patients survived at least 2\u00a0years after starting their first observed therapy for CLL. Our findings highlight considerable susceptibility to AEs and unmet medical need in Medicare patients with CLL treated in routine practice. Medicare incurred substantial economic burden following initiation of systemic therapy, and patients with greater numbers of AEs accounted disproportionately for the high overall cost of CLL management.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.3855","type":"journal-article","created":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T11:54:04Z","timestamp":1616068444000},"page":"2690-2702","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Overall survival, adverse events, and economic burden in patients with chronic lymphocytic leukemia receiving systemic therapy: Real\u2010world evidence from the medicare population"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1632-036X","authenticated-orcid":false,"given":"Ravi K.","family":"Goyal","sequence":"first","affiliation":[{"name":"RTI Health Solutions Research Triangle Park NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh P.","family":"Nagar","sequence":"additional","affiliation":[{"name":"RTI Health Solutions Research Triangle Park NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaum M.","family":"Kabadi","sequence":"additional","affiliation":[{"name":"AstraZeneca Gaithersburg MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Le","sequence":"additional","affiliation":[{"name":"AstraZeneca Gaithersburg MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith L.","family":"Davis","sequence":"additional","affiliation":[{"name":"RTI Health Solutions Research Triangle Park NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Kaye","sequence":"additional","affiliation":[{"name":"RTI Health Solutions Waltham MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,18]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"American Cancer Society.Cancer Facts & Figures.2020. Available at:https:\/\/www.cancer.org\/content\/dam\/cancer\u2010org\/research\/cancer\u2010facts\u2010and\u2010statistics\/annual\u2010cancer\u2010facts\u2010and\u2010figures\/2020\/cancer\u2010facts\u2010and\u2010figures\u20102020.pdf. Accessed: June 9 2020."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.14553"},{"key":"e_1_2_10_4_1","unstructured":"National Comprehensive Cancer Network.Clinical practice guidelines in oncology (NCCN Guidelines\u00ae): chronic lymphocytic leukaemia\/small lymphocytic lymphoma.2020. Available at:https:\/\/www.nccn.org\/professionals\/physician_gls\/default.aspx. Accessed: May 26 2020."},{"key":"e_1_2_10_5_1","unstructured":"American Cancer Society.Cancer Facts & Figures:2018. Available at:https:\/\/www.cancer.org\/research\/cancer\u2010facts\u2010statistics\/all\u2010cancer\u2010facts\u2010figures\/cancer\u2010facts\u2010figures\u20102018.html. 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