{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:58:37Z","timestamp":1789577917130,"version":"build-2803163510"},"reference-count":41,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"2","license":[{"start":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T00:00:00Z","timestamp":1659571200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["jheor.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":" Background<\/jats:title> Despite advances in tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia in chronic phase (CML-CP), a sizeable proportion of patients with CML-CP remains refractory or intolerant to these agents.<\/jats:p> <\/jats:sec> Objectives<\/jats:title> Treatment patterns, healthcare resource utilization (HRU), and costs were evaluated among patients with CML who received third or later lines of therapy (3L+), a clinical population that has not been previously well-studied, with unmet treatment needs as TKI therapy has repeatedly failed.<\/jats:p> <\/jats:sec> Methods<\/jats:title> Adult patients with CML who received 3L+ were identified in the IBM\u00ae MarketScan\u00ae Databases (January 1, 2001\u2013June 30, 2019) and the SEER-Medicare\u2013linked database (January 1, 2006\u2013December 31, 2016). Treatment patterns were observed from CML diagnosis. HRU and direct healthcare costs (payer\u2019s perspective, 2019 USD) were measured in a 3L+ setting.<\/jats:p> <\/jats:sec> Results<\/jats:title> Among 296 commercially insured patients with 3L+ (median age, 58.5 years; female, 49.7%), the median duration of first-line (1L), second-line (2L), and 3L therapy was 8.5, 4.2, and 8.3 months, respectively. The annual incidence rate during 3L+ was 3.4 for inpatient days, 30.8 for days with outpatient services, and 1.2 for emergency department visits. Mean per-patient-per-month (PPPM) total healthcare costs (pharmacy + medical costs) were $18\u202f784 in 3L+, $15\u202f206 in 3L, and $19\u202f546 in 4L, with inpatient costs driving most of the difference between 3L and 4L (mean [3L] = $2528 PPPM, mean [4L] = $6847 PPPM). Among 53 Medicare-insured patients with 3L+ (median age, 72.0 years; female, 39.6%), the median duration of 1L, 2L, and 3L therapy was 9.7, 5.0, and 7.0 months, respectively. During 3L+, the annual incidence rate was 10.3 for inpatient days, 61.9 for days with outpatient services, and 1.5 for emergency department visits. Mean PPPM total healthcare costs were $14\u202f311 in 3L+, $15\u202f100 in 3L, and $16\u202f062 in 4L.<\/jats:p> <\/jats:sec> Discussion<\/jats:title> Patients with CML receiving 3L+ rapidly cycled through multiple lines. Costs increased from 3L to 4L; in commercially insured patients, inpatient costs were responsible for most of the cost increase between 3L and 4L, underlying these patients\u2019 continued need for care.<\/jats:p> <\/jats:sec> Conclusions<\/jats:title> These findings support the need for better treatment options in patients with CML undergoing later lines of therapy.<\/jats:p> <\/jats:sec>","DOI":"10.36469\/001c.36975","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T16:08:58Z","timestamp":1659629338000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":3,"title":["Chronic Myeloid Leukemia: Part I\u2014Real-World Treatment Patterns, Healthcare Resource Utilization, and Associated Costs in Later Lines of Therapy in the United States"],"prefix":"10.36469","volume":"9","author":[{"given":"Ehab L.","family":"Atallah","sequence":"first","affiliation":[{"name":"Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Maegawa","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceuticals Corporation, East Hanover, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominick","family":"Latremouille-Viau","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Rossi","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Gu\u00e9rin","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Q.","family":"Wu","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pallavi","family":"Patwardhan","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceuticals Corporation, East Hanover, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22273","published-online":{"date-parts":[[2022,8,4]]},"reference":[{"key":"ref1","author":"US Food and Drug Administration","year":"2006","unstructured":"10. 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