{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:11:01Z","timestamp":1755216661342,"version":"3.43.0"},"reference-count":23,"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":"<jats:sec id=\"background\"> <jats:title>Background<\/jats:title> <jats:p>Tyrosine kinase inhibitors (TKIs) are the standard-of-care treatment for chronic myeloid leukemia in chronic phase (CML-CP). Despite advances in therapy, there remains a proportion of patients with CML-CP that are refractory\/intolerant to TKIs, and these patients cycle through multiple lines of therapy. Moreover, even with TKIs, some patients progress to accelerated phase\/blast crisis (AP\/BC), which is associated with particularly poor clinical outcomes.<\/jats:p> <\/jats:sec> <jats:sec id=\"objectives\"> <jats:title>Objectives<\/jats:title> <jats:p>To describe real-world treatment patterns, healthcare resource utilization (HRU), and costs of patients with CML-CP reaching later lines of therapy or progressing to AP\/BC in the United States.<\/jats:p> <\/jats:sec> <jats:sec id=\"methods\"> <jats:title>Methods<\/jats:title> <jats:p>Adult CML patients from administrative claims data (January 1, 2000\u2013June 30, 2019) were classified by health state: on third-line (CML-CP On Treatment), on fourth or later lines (CML-CP Post-Discontinuation), or progressed to AP\/BC (CML-AP\/BC). Outcomes were assessed by health state.<\/jats:p> <\/jats:sec> <jats:sec id=\"results\"> <jats:title>Results<\/jats:title> <jats:p>There were 296 (4620 patient-months), 83 (1644 patient-months), and 949 (25 593 patient-months) patients classified in the CML-CP On Treatment, CML-CP Post-Discontinuation, and CML-AP\/BC cohorts, respectively. Second-generation TKIs (nilotinib, dasatinib, and bosutinib) were most commonly used in the CML-CP On Treatment (69.1% of patient-months) and CML-CP Post-Discontinuation cohorts (59.1% of patient-months). Three-month outpatient incidence rates (IRs) were 7.6, 8.3, and 7.0 visits in the CML-CP On Treatment, CML-CP Post-Discontinuation, and CML-AP\/BC cohort, respectively, with mean costs of $597 per service. Three-month inpatient IRs were 0.6, 0.7, and 1.4 days in the CML-CP On Treatment, CML-CP Post-Discontinuation, and CML-AP\/BC cohort, respectively, with mean costs of $5892 per day. Mean hematopoietic stem cell transplantation cost was $352\u202f333; mean 3-month terminal care cost was $107 013.<\/jats:p> <\/jats:sec> <jats:sec id=\"discussion\"> <jats:title>Discussion<\/jats:title> <jats:p>Cost of CML care is substantial among patients with CML reaching third-line, fourth or later lines, or progressing to AP\/BC, suggesting that the disease is associated with a significant economic and clinical burden. From third-line to fourth or later lines, HRU was observed to increase, and the incidence of inpatient days was particularly high for those who progressed to AP\/BC.<\/jats:p> <\/jats:sec> <jats:sec id=\"conclusion\"> <jats:title>Conclusion<\/jats:title> <jats:p>In this study, patients with CML cycling through TKIs in later lines of therapy or progressing to AP\/BC experienced substantial HRU and costs, suggesting unmet treatment needs.<\/jats:p> <\/jats:sec>","DOI":"10.36469\/001c.36976","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T18:13:41Z","timestamp":1659636821000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Myeloid Leukemia: Part II\u2014Cost of Care Among Patients in Advanced Phases or Later Lines of Therapy in Chronic Phase in the United States from a Commercial Perspective"],"prefix":"10.36469","volume":"9","author":[{"given":"Ehab L.","family":"Atallah","sequence":"first","affiliation":[{"name":"Medical College of Wisconsin, Milwaukee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrigo","family":"Maegawa","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceuticals Corporation, East Hanover, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominick","family":"Latremouille-Viau","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmine","family":"Rossi","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annie","family":"Gu\u00e9rin","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"22273","published-online":{"date-parts":[[2022,8,4]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"publisher","first-page":"e163","DOI":"10.1016\/j.clml.2015.07.647","article-title":"Economic burden of tyrosine kinase inhibitor treatment failure in chronic myeloid leukemia","volume":"15","author":"Kevin B. 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