{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:44:03Z","timestamp":1784180643100,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T00:00:00Z","timestamp":1603929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","award":["14\u2010238\u201004\u2010IRG"],"award-info":[{"award-number":["14\u2010238\u201004\u2010IRG"]}],"id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with high cost\u2010sharing of tyrosine kinase inhibitors (TKIs) experience delays in treatment for chronic myeloid leukemia (CML). To the authors' knowledge, the clinical outcomes among and costs for patients not receiving TKIs are not well defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the Surveillance, Epidemiology, and End Results (SEER)\u2013Medicare database, the authors evaluated differences in TKI initiation, health care use, cost, and survival among patients with CML with continuous Medicare Parts A and B and Part D coverage who were diagnosed between 2007 and 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 941 patients were included. Approximately 29% of all patients did not initiate treatment with TKIs within 6 months (non\u2010TKI users), and had lower rates of <jats:italic>BCR\u2010ABL<\/jats:italic> testing and more hospitalizations compared with TKI users. Approximately 21% were not found to have any TKI claims at any time. TKI initiation rates within 6 months of diagnosis increased for all patients over time (61% to 85%), with greater improvements observed in patients receiving subsidies (55% to 90%). Total Medicare costs were greater in patients treated with TKIs, with approximately 50% because of TKI costs. Non\u2010TKI users had more inpatient costs compared with TKI users. Trends in cost remained significant when adjusting for age and comorbidities. The median overall survival was 40 months (95% confidence interval [95% CI], 34\u201048 months) compared with 86 months (95% CI, 73 months to not reached), respectively, for non\u2010TKI users versus TKI users, a finding that remained consistent when adjusting for age, comorbidities, and subsidy status (hazard ratio, 2.23; 95% CI, 1.77\u20102.81).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Approximately 21% of all patients with CML did not receive TKIs at any time. Cost\u2010sharing subsidies consistently are found to be associated with higher initiation rates. Non\u2010TKI users had higher inpatient costs and poorer survival outcomes. Interventions to lower TKI costs for all patients are desirable.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.33267","type":"journal-article","created":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T10:23:55Z","timestamp":1603967035000},"page":"93-102","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The costs of treating and not treating patients with chronic myeloid leukemia with tyrosine kinase inhibitors among Medicare patients in the United States"],"prefix":"10.1002","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0242-4352","authenticated-orcid":false,"given":"Erlene K.","family":"Seymour","sequence":"first","affiliation":[{"name":"Department of Oncology Karmanos Cancer Institute Wayne State University Detroit Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie J.","family":"Ruterbusch","sequence":"additional","affiliation":[{"name":"Department of Oncology Karmanos Cancer Institute Wayne State University Detroit Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2906-3913","authenticated-orcid":false,"given":"Aaron N.","family":"Winn","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Medical College of Wisconsin Milwaukee Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"George","sequence":"additional","affiliation":[{"name":"Department of Oncology Karmanos Cancer Institute Wayne State University Detroit Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4320-739X","authenticated-orcid":false,"given":"Jennifer L.","family":"Beebe\u2010Dimmer","sequence":"additional","affiliation":[{"name":"Department of Oncology Karmanos Cancer Institute Wayne State University Detroit Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4188-7886","authenticated-orcid":false,"given":"Charles A.","family":"Schiffer","sequence":"additional","affiliation":[{"name":"Department of Oncology Karmanos Cancer Institute Wayne State University Detroit Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.58.2320"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2016.014639"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0279"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw205"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.0830"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.64.6620"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.52.9123"},{"issue":"4","key":"e_1_2_8_9_1","first-page":"s78","article-title":"High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia","volume":"22","author":"Doshi JA","year":"2016","journal-title":"Am J Manag Care"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.67.4184"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_8_12_1","volume-title":"Comorbidity SAS Macro (2014 version)","author":"Healthcare Delivery Research Program","year":"2018"},{"key":"e_1_2_8_13_1","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2018"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31050"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2007.1.376"},{"key":"e_1_2_8_16_1","unstructured":"Centers for Medicare and Medicaid Services.HCPCS\u2010General Information. Published2020. Accessed September 28 2020.https:\/\/www.cms.gov\/Medicare\/Coding\/MedHCPCSGenInfo"},{"key":"e_1_2_8_17_1","unstructured":"US Bureau of Labor Statistics United States Department of Labor.CPI Inflation Calculator. Published2018. Accessed September 28 2020.https:\/\/www.bls.gov\/data\/inflation_calculator.htm"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-040617-013517"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32137"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.67.3350"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.72.2447"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0614-0"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2019.25.10.1140"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw003"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(19)30087-0"},{"issue":"3","key":"e_1_2_8_26_1","first-page":"S39","article-title":"Reducing out\u2010of\u2010pocket cost barriers to specialty drug use under Medicare Part D: addressing the problem of \u201ctoo much too soon.\u201d","volume":"23","author":"Doshi JA","year":"2017","journal-title":"Am J Manag Care"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(11)70043-2"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2012.0005"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24887"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V92.5.1541"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.33267","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncr.33267","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.33267","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T13:16:02Z","timestamp":1760274962000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.33267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,29]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1002\/cncr.33267"],"URL":"https:\/\/doi.org\/10.1002\/cncr.33267","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,29]]},"assertion":[{"value":"2020-07-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}