scholarly journals A Systematic Review to Assess the Impact of Non-Adherence to Treatments on Health Care Cost in Chronic Myeloid Leukemia

2016 ◽  
Vol 19 (3) ◽  
pp. A156-A157
Author(s):  
J Gupta ◽  
S Kamra ◽  
P Joshi ◽  
M Sehgal
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Health Care Cost ◽  
The Impact

HSR19-090: Changes in Adherence to Tyrosine Kinase Inhibitor Treatment Patterns Among Patients With Chronic Myeloid Leukemia and the Impact on Costs: 2001–2017

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-090
Author(s):  
Henry J. Henk ◽  
Lena E. Winestone ◽  
Jennifer J. Wilkes ◽  
Laura Becker ◽  
Pamela Morin ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Myeloid Leukemia ◽  
Healthcare Costs ◽  
Myeloid Leukemia ◽  
First Line ◽  
Tki Treatment ◽  
The Impact ◽  
Care Costs ◽  
Over Time ◽  
Privately Insured

Background: Chronic myeloid leukemia (CML) treatment improved considerably after introduction of oral tyrosine kinase inhibitors (TKI). As a result, the number of patients living with CML may reach 250,000 by 2040. We track changes in TKI treatment adherence since 2001 and provide an early assessment of treatment costs following the availability of second-generation TKIs and generic imatinib. Methods: A retrospective cohort from the OptumLabs Data Warehouse, which includes claims data for privately insured and Medicare Advantage (MA) enrollees in a large private U.S. health plan with medical and pharmacy benefits, was used. Patients with CML initiated TKI treatment between May 2001 and October 2016 and were continuously enrolled in the health plan 6 months prior through 12 months following TKI start. Adherence was defined by medication possession ratio (MPR1=total days’ supply of imatinib in 1st year divided by 365, 1=perfect adherence). Total health care costs include medical and prescription medication benefits. MPR1 was modeled using ordinary least squares regression. The association between MPR1 and healthcare costs was estimated using a generalized linear model specified with a gamma error distribution and a log link. Results: We identified 1,793 eligible patients. First-line TKI has changed over time (dasatinib and nilotinib represent 45% of all 2016 starts; imatinib 55%). From 2001 to 2016, adherence increased (Table 1). MPR1 was higher in men and increased with age until age ∼62 after which it declined. MPR1 was lower for patients with more comorbid conditions prior to treatment. Overall, MPR1 was inversely associated with total health care costs (medical and pharmacy) among privately insured (P<.001) but not MA enrollees. The net impact of MPR1 on total healthcare costs diminished over time (P<.001) where a 10% point decrease in MPR1 was associated with 12% and 4% lower total costs, prior to and following availability of 2nd generation TKIs, respectively. When examining medical costs only, MPR1 was inversely associated with medical costs for both privately insured (P<.001) and MA enrollees (P=.016). Conclusions: We found that adherence to TKI treatment increased over time. While imatinib is still used more frequently than other TKIs as first-line therapy, second-generation TKIs are becoming increasingly used as first-line agents. Possible cost-offsets are decreasing over time but it may be too early to formally evaluate the impact of generic imatinib.

The impact of health care settings on survival time of patients with chronic myeloid leukemia

Blood ◽  
2014 ◽  
Vol 123 (16) ◽  
pp. 2494-2496 ◽  
Author(s):  
Michael Lauseker ◽  
Joerg Hasford ◽  
Markus Pfirrmann ◽  
Rüdiger Hehlmann
Keyword(s):  
Health Care ◽  
Chronic Myeloid Leukemia ◽  
Survival Time ◽  
Myeloid Leukemia ◽  
Health Care Settings ◽  
Key Points ◽  
The Impact

Key Points CML patients enjoyed superior survival chances when treated in THs. Treatment centers having less experience with CML patients did not affect the patient’s survival chances.

PCN63 Systematic Review of Utility Estimates for Health States Associated with Chronic Myeloid Leukemia

2021 ◽  
Vol 24 ◽  
pp. S31
Author(s):  
R. Agrawal ◽  
J. Vieira ◽  
J. Ryan ◽  
D. Thakur ◽  
R. Viana
Keyword(s):  
Systematic Review ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Health States

scholarly journals DNA Methylation and Intra-Clonal Heterogeneity: The Chronic Myeloid Leukemia Model

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3587
Author(s):  
Benjamin Lebecque ◽  
Céline Bourgne ◽  
Véronique Vidal ◽  
Marc G. Berger
Keyword(s):  
Dna Methylation ◽  
Chronic Myeloid Leukemia ◽  
Fusion Protein ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Single Gene ◽  
Clonal Heterogeneity ◽  
Sequencing Technologies ◽  
Genome Wide ◽  
The Impact

Chronic Myeloid Leukemia (CML) is a model to investigate the impact of tumor intra-clonal heterogeneity in personalized medicine. Indeed, tyrosine kinase inhibitors (TKIs) target the BCR-ABL fusion protein, which is considered the major CML driver. TKI use has highlighted the existence of intra-clonal heterogeneity, as indicated by the persistence of a minority subclone for several years despite the presence of the target fusion protein in all cells. Epigenetic modifications could partly explain this heterogeneity. This review summarizes the results of DNA methylation studies in CML. Next-generation sequencing technologies allowed for moving from single-gene to genome-wide analyses showing that methylation abnormalities are much more widespread in CML cells. These data showed that global hypomethylation is associated with hypermethylation of specific sites already at diagnosis in the early phase of CML. The BCR-ABL-independence of some methylation profile alterations and the recent demonstration of the initial intra-clonal DNA methylation heterogeneity suggests that some DNA methylation alterations may be biomarkers of TKI sensitivity/resistance and of disease progression risk. These results also open perspectives for understanding the epigenetic/genetic background of CML predisposition and for developing new therapeutic strategies.

scholarly journals Systematic Review of Patient Reported Outcomes in Chronic Myeloid Leukemia

2013 ◽  
Vol 16 (7) ◽  
pp. A420-A421
Author(s):  
S. Aggarwal ◽  
J. Segal ◽  
H. Topaloglu
Keyword(s):  
Systematic Review ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Patient Reported Outcomes ◽  
Patient Reported

The Impact of Symptom Burden on Patient Quality of Life in Chronic Myeloid Leukemia

Oncology ◽  
2014 ◽  
Vol 87 (3) ◽  
pp. 133-147 ◽  
Author(s):  
David Cella ◽  
Cindy J. Nowinski ◽  
Olga Frankfurt
Keyword(s):  
Quality Of Life ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Symptom Burden ◽  
The Impact

scholarly journals P070: Mixed effectiveness of emergency department diversion strategies: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S102
Author(s):  
S.W. Kirkland ◽  
A. Soleimani ◽  
B.H. Rowe ◽  
A.S. Newton
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Services ◽  
Grey Literature ◽  
Study Data ◽  
Care Utilization ◽  
Alternative Source ◽  
Increased Risk ◽  
The Impact

Introduction: Diverting patients away from the emergency department (ED) has been proposed as a solution for reducing ED overcrowding. The objective of this systematic review is to examine the effectiveness of diversion strategies designed to either direct patients seeking care at an ED to an alternative source of care. Methods: Seven electronic databases and grey literature were searched. Randomized/controlled clinical trials and cohort studies assessing the effectiveness of pre-hospital and ED-based diversion interventions with a comparator were eligible for inclusion. Two reviewers independently screened the studies for relevance, inclusion, and risk of bias. Intervention effects are reported as proportions (%) or relative risks (RR) with 95% confidence intervals (CI). Methodological and clinical heterogeneity prohibited pooling of study data. Results: From 7,306 citations, ten studies were included. Seven studies evaluated a pre-hospital diversion strategy and three studies evaluated an ED-based diversion strategy. The impact of diversion on subsequent health services was mixed. One study of paramedic practitioners reported increased ED attendance within 7 days (11.9% vs. 9.5%; p=0.049) but no differences in return visits for similar conditions (75.2% vs. 72.1%; p=0.64). The use of paramedic practitioners was associated with an increased risk of subsequent contact with health care services (RR=1.21, 95% CI 1.06, 1.38), while the use of deferred care was associated with no increase in risk of subsequently seeking physician care (RR=1.09, 95% CI 0.23, 5.26). While two studies reported that diverted patients were at significantly reduced risk for hospitalization, two other studies reported no significant differences between diverted or standard care patients. Conclusion: The evidence regarding the impact of pre-hospital and ED-based diversion on ED utilization and subsequent health care utilization is mixed. Additional high-quality comparative effectiveness studies of diversion strategies are required prior to widespread implementation.

scholarly journals Ageing, limb-loss and military veterans: a systematic review of the literature

2018 ◽  
Vol 39 (8) ◽  
pp. 1582-1610 ◽  
Author(s):  
NICK CADDICK ◽  
HELEN CULLEN ◽  
AMANDA CLARKE ◽  
MATT FOSSEY ◽  
MICHAEL HILL ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Military Service ◽  
Military Veterans ◽  
Limb Loss ◽  
Cochrane Library ◽  
Term Care ◽  
Long Term Impact ◽  
The Impact

ABSTRACTThe impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.

scholarly journals The impact of introducing tyrosine kinase inhibitors on chronic myeloid leukemia survival: a population-based study

BMC Cancer ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Enza Di Felice ◽  
Francesca Roncaglia ◽  
Francesco Venturelli ◽  
Lucia Mangone ◽  
Stefano Luminari ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Population Based ◽  
Population Based Study ◽  
The Impact
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