Comparison of Adherence Between Nilotinib and Dasatinib As Second-Line Therapies in Chronic Myeloid Leukemia

Abstract Abstract 2754 Background: According to the NCCN guidelines, the recommended treatment option for patients diagnosed with Philadelphia-positive (Ph+) chronic myeloid leukemia (CML) in chronic or accelerated phases who are resistant or develop intolerance to first-line imatinib is to switch to one of the two second-generation BCR-ABL tyrosine kinase inhibitors, nilotinib or dasatinib. There is limited information on their comparative adherence. Analysis of adherence may reveal whether these two drugs are being used as intended and how adherence issues may potentially affect clinical outcomes. Nonadherence to imatinib has been associated with loss of cytogenetic response, imatinib failure, and higher rates of inpatient visits. A prior study covering the period up to 6/2009 has revealed a better adherence profile for nilotinib versus dasatinib. Since dasatinib was approved for once daily use in addition to twice daily use in 05/2009, this study replicated the analysis using more recent data to compare adherence between nilotinib and dasatinib as second-line therapies in CML. Methods: Medical and pharmacy records from two databases from January 1997 to April 2010 were combined to identify adult patients diagnosed with CML (ICD-9 code 205.1x) with ≥1 prescription for either nilotinib or dasatinib. Patients were required to have continuous enrollment ≥1 month prior to and after the index date, defined as the first prescription for nilotinib or dasatinib, and to continue their treatment ≥1 month before discontinuing or switching to another TKI. Adherence over an up-to 180-day period was evaluated based on the proportion of days covered (PDC; sum of days of medication on hand for nilotinib or dasatinib divided by the number of calendar days in the study period). Medication possession ratio (MPR) was also evaluated in a sensitivity analysis. PDC and MPR were compared between cohorts using linear regression models. Discontinuation was defined as a treatment gap ≥30 days, and rates were compared between cohorts using Kaplan-Meier survival analyses and Cox proportional hazard regression models. In a sensitivity analysis, discontinuation was defined as a treatment gap ≥90 days. All multivariate regression models were controlled for age, gender, CML complexity, adverse events at baseline, number of inpatient days, emergency room (ER) visits and outpatient visits during baseline, medical costs during baseline, CML year of diagnosis, Charlson Comorbidity Index, and bone marrow or stem cell transplant before the index date. Results: Adherence and discontinuation were analyzed for a total of 558 CML patients receiving a second-line TKI (473 dasatinib and 85 nilotinib). Patient characteristics were generally similar. Patients in the dasatinib cohort had a longer mean follow-up period compared with those in the nilotinib cohort (162 days vs. 146 days; P = 0.0007) and greater utilization and costs associated with inpatient and ER services. The mean PDC over the study period for nilotinib was higher compared with dasatinib (0.81 vs 0.68). After adjusting for confounding factors, the nilotinib group had a 0.115 higher PDC (approximately 17% higher) compared to the dasatinib group (P = 0.0004). Additionally, patients in the nilotinib group had a significantly higher MPR compared to patients in the dasatinib group (0.90 vs. 0.77 P = 0.0043). Discontinuation rates (gap ≥30 days) were significantly higher for dasatinib users than for nilotinib users, with an adjusted hazard ratio of 2.15 (P = 0.0013). Dasatinib-treated patients had higher discontinuation rates than nilotinib-treated patients after 3 months (40% vs 22%) and 6 months (50% vs 28%). These unadjusted differences were robust in the sensitivity analysis with discontinuation defined as a treatment gap ≥90 days, but the difference between the cohorts was no longer significant after adjusting for confounding factors (HR 1.76, P = 0.1328). Conclusions: This retrospective study showed that CML patients treated with nilotinib for second-line treatment were significantly more adherent to therapy, based on PDC and MPR, and had a lower discontinuation rate than did patients receiving dasatinib in this analysis. Further studies are needed to better understand treatment-specific factors affecting adherence and persistence (e.g., treatment cost, tolerability profile, dosing convenience). Disclosures: Guerin: Novartis Pharmaceutical Corporation: Annie Guerin is an employee of Analysis Group, Inc, which has received research funds from Novartis Pharmaceuticals. Bollu:Novartis Pharmaceutical Corporation: Employment, Vamsi K. Bollu worked for the Novartis Pharmaceuticals Corporation while performing this analysis but is currently employed by Sunovion Pharmaceuticals Inc. Sunovion Pharmaceuticals Inc. was not in any way associated with this study. Guo:Novartis Pharmaceutical Corporation: Employment. Stepner:Novartis Pharmaceutical Corporation: Michael Stepner is an employee of Analysis Group, Inc, which has received research funds from Novartis Pharmaceuticals. Griffin:Novartis Pharmaceutical Corporation: James D. Griffin is an employee of the Dana Farber Institute which has received consultancy fees from Analysis Group, Inc, which has received research funds from Novartis Pharmaceuticals Corporation. Wu:Novartis Pharmaceutical Corporation: Eric Q. Wu is an employee of Analysis Group, Inc, which has received consultancy funds from Novartis Pharmaceutical Corporation.

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Comparison of Adherence Between Nilotinib and Dasatinib as Second-Line Therapies In Chronic Myeloid Leukemia.

Blood ◽

10.1182/blood.v116.21.3437.3437 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3437-3437 ◽

Cited By ~ 1

Author(s):

Annie Guerin ◽

Vamsi Bollu ◽

Amy Guo ◽

James D. Griffin ◽

Andrew Peng Yu ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Treatment Adherence ◽

Myeloid Leukemia ◽

Index Date ◽

Medication Possession Ratio ◽

Data Availability ◽

Administrative Claims ◽

Cell Transplant ◽

Second Line ◽

Significant Difference

Abstract Abstract 3437 Background: The recommended treatment option for patients diagnosed with chronic myeloid leukemia (CML) who do not achieve hematological or cytogenetic response to first-line imatinib therapy is to switch to one of the two new BCR-ABL tyrosine kinase inhibitors, nilotinib or dasatinib. Both drugs appear to be efficacious; however, there are no direct comparisons for treatment adherence between nilotinib and dasatinib. Analysis of adherence may reveal whether these two drugs are being used as intended and how adherence issues may potentially affect clinical outcomes. Previously, higher imatinib adherence was associated with significantly lower utilization of resources and costs. (Wu EQ, et al. Curr Med Res Opin. 2010;26:61-69.) The objective of this retrospective study was to compare adherence associated with second-line nilotinib versus dasatinib in a real-world setting. Methods: Two administrative claims databases were combined (MarketScan and Ingenix Impact, 01/2002-12/2008) to identify patients diagnosed with CML (ICD-9 code 205.1x) who had received ≥1 prescription for either nilotinib or dasatinib. Patients were required to have continuous enrollment ≥1 month prior to and after the index date. The index date was defined as the first prescription for nilotinib or dasatinib. Patients were followed for up to 6 months from the index date to the earliest of the termination of health care plan enrollment, or end of data availability. Treatment adherence was measured by the proportion of days covered (PDC) and compared using generalized linear models. PDC was calculated as the sum of the days of supply for nilotinib or dasatinib, divided by the number of calendar days in the study period (i.e., up to 6 months after the index date). Unadjusted average PDCs were compared between nilotinib and dasatinib users using Wilcoxon sum-rank tests. Multivariate regressions were controlled for age, gender, CML disease complexity, any adverse event at baseline, CML year of diagnosis, comorbidities, and bone marrow or stem cell transplant at baseline. Medication possession ratios and discontinuation rates, defined as a treatment gap ≥30 days, were also evaluated. Results: A total of 521 patients receiving a second-line TKI (452 dasatinib and 69 nilotinib) were studied. Patients had a mean age of 57 years, and all other characteristics were similar between the 2 cohorts with the exception that patients in the dasatinib cohort had a longer mean follow-up period compared to those in the nilotinib cohort (161.6 days vs 141.9 days; P = 0.0105). Patients in the dasatinib cohort were less adherent to their therapy compared to nilotinib patients. The PDC (mean ± standard deviation) over the study period was 0.79 ± 0.23 for nilotinib patients and 0.69 ± 0.28 for dasatinib patients. After adjustment, dasatinib patients were estimated to have a 0.096 lower PDC value (approximately 13% lower) compared with nilotinib patients (P = 0.0086). A greater proportion of dasatinib users had a PDC <0.8 and PDC <0.9 (Figure). A statistically significant difference in medication possession ratios at 180 days was also observed; 0.75 ± 0.33 for dasatinib and 0.85 ± 0.27 for nilotinib (P = 0.029). Discontinuation rates were similar between the two drugs with an adjusted hazard ratio (HR) of 1.03 (HR >1 indicates that dasatinib users have a greater discontinuation rate than nilotinib users; 95% confidence interval, 0.63–1.69; P = 0.8981). Conclusions: CML patients treated with second-line nilotinib had significantly better adherence during the 6-month study period than patients treated with second-line dasatinib as defined by the PDC. The medication possession ratio was also greater for nilotinib-treated than dasatinib-treated patients; however, discontinuation rates were similar between the two treatment groups. Although adherence may be related to a greater safety profile as adverse events may disrupt treatment, head-to-head comparisons of the drugs as second-line therapy for CML have not been performed. Further research is necessary to understand and define all factors, including safety, involved in affecting treatment adherence for nilotinib and dasatinib patients. Disclosures: Guerin: Analysis Group, Inc.: Employment. Bollu:Novartis: Employment. Guo:Novartis: Employment. Griffin:Novartis: Consultancy, Research Funding. Yu:Analysis Group, Inc.: Employment. Wu:Analysis Group, Inc.: Employment.

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A Retrospective Analysis of Treatment Patterns in Elderly Patients with Chronic Myeloid Leukemia Receiving Dasatinib or Nilotinib As Second-Line Therapy after Imatinib

Blood ◽

10.1182/blood.v124.21.1293.1293 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1293-1293

Author(s):

B. Douglas Smith ◽

Jun Liu ◽

Dominick Latremouille-Viau ◽

Zhou Zhou ◽

Annie Guerin ◽

...

Keyword(s):

Elderly Patients ◽

Myeloid Leukemia ◽

Research Funding ◽

Index Date ◽

Treatment Patterns ◽

Harvard University ◽

Second Line ◽

Analysis Group ◽

Percentage Points

Abstract Introduction: Dasatinib and nilotinib are second-generation tyrosine kinase inhibitors (TKIs) originally approved as second-line treatment for patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in chronic phase resistant or intolerant to imatinib. Despite the fact that one half of patients with CML are ≥65 years of age, elderly patients are often under-recruited in clinical trials and there are few studies that focus on these often medically complex patients. This study aimed to compare treatment patterns of elderly CML patients initiating dasatinib vs nilotinib as second-line TKI therapy after imatinib therapy in a real-world setting. Methods: Elderly Medicare beneficiaries (≥65 years old) with ≥2 CML diagnoses who initiated dasatinib or nilotinib following prior treatment with imatinib were identified in the Medicare Research Identifiable Files (RIF) from 2006 to 2012. Selected patients were continuously covered by Part A (i.e., institutional claims), Part B (i.e., non-institutional claims), and Part D (i.e., drug events) for ≥6 months before and ≥1 month after the second-line TKI therapy initiation date (i.e., index date). Patients were excluded from the study if they were enrolled in a clinical trial, had a stem-cell transplant, or received chemotherapy (except hydroxyurea) within the 6 months before the index date (i.e., baseline period). Patients were classified as dasatinib users or nilotinib users based on the second-line TKI therapy. Dose decreases and increases, defined as a dose change of ≥20mg for dasatinib and ≥100mg for nilotinib compared to the initial dose, were measured from the index date up to the end of follow-up or treatment discontinuation. Treatment adherence was measured using the proportion of days covered (PDC) during the 6- and 12-month periods following the index date and among patients with continuous insurance coverage during these periods. Treatment persistence, measured between the index date and the end of follow-up, included time to treatment discontinuation (i.e., a treatment gap of ≥30 consecutive days) or switch to another TKI. Multivariate regression analyses were used to test for statistical significance while adjusting for potential confounding factors. Results: Of the 659 patients that met the sample selection criteria, 379 were dasatinib users and 280 were nilotinib users. The average age was 76 years (inter-quartile range 70 – 81) and 62% were female. After the index date, 88% of selected patients were observed for ≥6 months and 73% for ≥12 months. The average patient follow-up was 24 months (median=22 months). Dasatinib users were more likely to start on the recommended dose compared to nilotinib users (74% vs 53%; p<.001); only 15% of dasatinib users started on a dose ≤70mg/day and 10% started on 140mg/day; also 18% of nilotinib users started on ≤400mg/day and 24% started on 600mg/day. Dose reductions were almost twice as common in dasatinib users (21% vs 11%; adjusted hazard ratio [HR]=1.94; p=.002) and dose increases were also more common in dasatinib users (9% vs 7%; adjusted HR=1.81; p=.048) compared with nilotinib users. During the 6- and 12-month periods following the index date, dasatinib and nilotinib users had similar adherence level (6-month period: average PDC=78% for dasatinib vs 76% for nilotinib, adjusted mean difference=1.19 percentage points, p=.520; 12-month period: average PDC=69% for dasatinib vs 70% for nilotinib, adjusted mean difference=-1.37 percentage points, p=.570). Nilotinib users were more persistent compared to dasatinib users as fewer patients discontinued (59% vs 67%; adjusted HR=0.79; p=.024) or switched to another TKI treatment (21% vs 29%; adjusted HR=0.72; p=.049). Conclusion: There are little data available on treatment patterns of elderly CML patients. This study suggests that it is hard to determine the right starting dose of drug in elderly patients receiving a second generation TKI following treatment with imatinib. Interestingly, those receiving nilotinib had fewer dose adjustments (decreases or increases) and were more persistent (fewer discontinuation and switching) compared to those receiving dasatinib despite having similar levels of adherence over the first 6- and 12-month periods following the treatment initiation. Studies which focus on patients with elderly CML may help to provide better treatment guidelines for this important population. Disclosures Liu: Jun Liu is an employee of Harvard University which has received research funding from Analysis Group, Inc.: Employment. Latremouille-Viau:Dominick Latremouille-Viau is an employee of Analysis Group, Inc. which has received consulting fees from Novartis Pharmaceuticals Corporation: Employment. Zhou:Zhou Zhou is an employee of Analysis Group, Inc. which has received consulting fees from Novartis Pharmaceuticals Corporation: Employment. Guerin:Annie Guerin is an employee of Analysis Group, Inc. which has received consulting fees from Novartis Pharmaceuticals Corporation: Employment. Fernandez:Daniel Fernandez is an employee of Harvard University which has received research funding from Analysis Group, Inc.: Employment. Yi:Dingdong Yi is an employee of Harvard University which has received research funding from Analysis Group, Inc.: Employment. Wang:Xufei Wang is an employee of Harvard University which has received research funding from Analysis Group, Inc.: Employment. Wu:Eric Q. Wu is an employee of Analysis Group, Inc. which has received consulting fees from Novartis Pharmaceuticals Corporation: Employment. Mhatre:Novartis Pharmaceuticals Corporation: Employment. Keir:Novartis: Employment, Equity Ownership. Chen:Novartis Pharmaceuticals Corporation: Employment; Novartis: stock options Other.

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Major Adverse Cardiac, Arterial Occlusive, and Venous Occlusive Events Among Chronic Myeloid Leukemia Patients Prescribed Ponatinib Vs Bosutinib

Blood ◽

10.1182/blood-2019-129053 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4751-4751

Author(s):

Moshe Yair Levy ◽

Lin Xie ◽

Yuexi Wang ◽

Frank Neumann ◽

Shouryadeep Srivastava ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Pharmaceutical Company ◽

Cardiovascular Events ◽

Myeloid Leukemia ◽

Index Date ◽

Research Database ◽

Pharmaceutical Corporation ◽

Diagnosis Codes ◽

Wholly Owned Subsidiary

INTRODUCTION: Chronic myeloid leukemia (CML) is a bone marrow and blood disorder accounting for 15% of adult leukemia. Tyrosine kinase inhibitors (TKIs) have been the standard of care for CML treatment. However, an association between TKI use and cardiovascular events has been observed. Ponatinib and bosutinib are introduced to provide more options for patients who failed their first-line treatment. The incidence of major adverse cardiac events (MACEs), arterial occlusive events (AOEs), and venous occlusive events (VOEs) were assessed among CML patients who were prescribed ponatinib vs bosutinib. METHODS: A retrospective observational study was conducted among adult CML patients aged ≥18 years with use of 1 or 2 prior TKIs who were prescribed bosutinib or ponatinib. Study patients were selected from the IBM® MarketScan® Research database from July 2012-June 2017. The index date was defined as the index drug prescription date, identified based on TKI use during the identification period (January 2013-December 2016) in a hierarchical order based on the sequence of treatment lines: ponatinib and bosutinib without ponatinib. Continuous health plan enrollment for ≥6 months pre-index date (baseline period) and at least 6 months post-index date (follow-up period) was required. Cardiovascular (CV) events (MACEs, AOEs, VOEs) using ICD-9/10-CM diagnosis codes occurring through the earliest of index TKI discontinuation, switch to another TKI, or end of follow-up period, were calculated as the number of events per 100 person-years (PYs). Inverse probability of treatment weighting (IPTW) was applied to adjust for differences in baseline characteristics between the treatment cohorts. Kaplan-Meier (KM) and Cox proportional hazard model analyses were conducted on the adjusted sample to examine any difference in CV event risk. RESULTS: After applying the selection criteria, 79 and 109 patients were included in the ponatinib and bosutinib cohorts, respectively. Mean ages were 53 years (ponatinib cohort) and 58 years (bosutinib cohort). The average Charlson Comorbidity Index (CCI) scores - defined by categorizing comorbidities using diagnosis codes - were 1.23 for ponatinib and 1.81 for the bosutinib cohort. Common baseline comorbid conditions included anemia (ponatinib: 49%; bosutinib 34%), hypertension (ponatinib: 33%, bosutinib: 46%), and diabetes (ponatinib: 15%; bosutinib: 29%). Some patients were observed to have CV events, specifically MACEs (ponatinib 8%; bosutinib 16%) and AOEs (ponatinib 15%; bosutinib 28%), before index ponatinib or bosutinib use. In the follow-up period, ponatinib patients were associated with a similar incidence of MACEs (14.70 vs 10.46 per 100 PYs; p=0.464), AOEs (29.56 vs 34.50 per 100 PYs; p=0.632), and VOEs (36.21 vs 34.70 per 100 PYs; p=0.890) compared to bosutinib patients. After applying IPTW, similar risks of the CV events (MACE, AOEs, VTEs) were observed in the KM analysis (Figure 1) expressed as time to CV event. After adjusting for additional confounders using Cox models, compared to those with bosutinib use, ponatinib patients were associated with similar rate of MACEs (Hazard Ratio [HR]: 1.02; 95% CI: 0.34, 3.01), AOEs (HR: 0.90; 95% CI: 0.43, 1.85), and VOEs (HR: 0.92; 95% CI: 0.44, 1.94). CONCLUSION: Among CML patients treated with ponatinib or bosutinib in second or third line, similar risks of cardiovascular events (MACE, AOEs, VTEs) were observed in the follow-up in this study in a community setting. Figure 1 Disclosures Levy: Takeda (Millennium Pharmaceuticals): Consultancy. Xie:STATinMED Research: Other: I am a paid employee of STATinMED Research which is a paid consultant to Takeda Pharmaceutical Corporation. . Wang:STATinMED Research: Other: I am a paid employee of STATinMED Research which is a paid consultant to Takeda Pharmaceutical Company. . Neumann:Millennium Pharmaceuticals (Takeda): Employment, Other: I am a paid employee of Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd. Srivastava:Millennium Pharmaceuticals (Takeda): Other: I am a paid employee of Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd. Naranjo:Millennium Pharmaceuticals (Takeda): Other: I am a paid employee of Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd. Xu:Millennium Pharmaceuticals (Takeda): Other: I am a paid employee of Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd. Zhang:STATinMED Research: Other: I am a paid employee of STATinMED Research which is a paid consultant to Takeda Pharmaceutical Corporation.. Dalal:Millennium Pharmaceuticals (Takeda): Other: I am a paid employee of Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd.

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Comparison of Healthcare Utilization and Costs Between Nilotinib and Dasatinib as Second Line Therapies in Chronic Myeloid Leukemia.

Blood ◽

10.1182/blood.v114.22.4286.4286 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4286-4286

Author(s):

Eric Qiong Wu ◽

Vamsi K Bollu ◽

Amy Guo ◽

Annie Guerin ◽

Magda Tsaneva ◽

...

Keyword(s):

Myeloid Leukemia ◽

Index Date ◽

Therapy Group ◽

Second Line ◽

Second Line Therapy ◽

Medical Visits ◽

Analysis Group ◽

Outpatient Visits ◽

Line Therapy ◽

The Difference

Abstract Abstract 4286 Introduction Dasatinib and nilotinib are both indicated to treat chronic myeloid leukemia (CML) patients resistant or intolerant to imatinib. This study compared retrospectively the healthcare resource utilization and costs associated with dasatinib versus nilotinib treatment as second line therapies in CML patients. Patients and Methods Two large administrative claims databases were combined (MarketScan and Ingenix Impact, 01/2002-12/2008) to identify patients diagnosed with CML (ICD-9 code 205.1x) and treated with a tyrosine kinase inhibitor (TKI) second line therapy. Patients with at least 1 prescription of dasatinib or nilotinib and no prior use of TKI other than imatinib were selected to form the dasatinib second line therapy group and nilotinib second line therapy group, respectively. The index date was defined as the first prescription for dasatinib or nilotinib. Only patients with an index date on or after the date of nilotinib FDA approval (10/27/2007) and continuously enrolled at least 1 month prior to and 1 month after the index date were included. Patients were followed for up to 6 months from the index date to the earliest of the termination of healthcare plan enrollment, or end of data availability. Patient total medical visits, as well as outpatient visits and hospitalization days, were compared between the two groups using incidence rate ratios (IRR). Multivariate negative binomial regression models were applied to estimate IRR while adjusting for baseline differences of the two groups. Patient total costs, pharmacy costs, and medical service costs (including costs associated with outpatient visits, inpatient admissions, emergency room visits, and other medical services) were compared between the nilotinib and dasatinib group. Unadjusted and adjusted cost differences were estimated for each cost component using generalized linear models (GLM) or two-part models. Multivariate regression models to compare patient utilization and costs controlled for potential differences in age, gender, and cancer complexity (Darkow 2007) between the two groups. Costs were adjusted for inflation to 2008 U.S. dollars. Results A total of 230 CML patients treated with a second line TKI met the selection criteria; 186 patients treated with dasatinib and 44 patients treated with nilotinib were identified. Average age was similar between the two groups: 56.9 ± 16.3 in dasatinib patients and 54.1 ± 12.4 in nilotinib patients (p=.366) and the ratio of females was not statistically different: 44.1% v 56.8% (p=.128). Comorbidity burden, measured by the Charlson comorbidity index, was also similar between the two groups: 3.12 ± 1.90 for dasatinib patients vs. 3.07 ± 1.95 for nilotinib patients (p=.638), as was the proportion of patients with moderate and severe CML complexity: 53.8% vs 61.4% (p=.362) and 27.4% vs 22.7% (p=.526) for dasatinib and nilotinib treated patients, respectively. Mean duration of prior imatinib treatment for both groups was not statistically significant (p=0.189), 662.1 days vs 583.8 days, for nilotinib Vs dasatinib, respectively. Over the follow-up period, dasatinib patients had significantly more medical visits (IRR=1.32, p=.028), as well as outpatient visits (IRR=1.31, p=.033). Dasatinib patients also had 36% more hospital days but the difference was not statistically significant (IRR=1.36, p=0.664). Over the 6 months following the initiation of the second line therapy, compared to patients on nilotinib, patients on dasatinib incurred $18,328 (p<.001) more in total medical services and $6,367 (p=0.04) less in pharmacy costs, resulting in a higher net total healthcare cost of $12,039 (p=.035). The difference in medical costs was mainly explained by the difference of inpatient costs ($12,480 higher for dasatinib patients; p=<.001) and outpatient costs ($5,035 higher for dasatinib patients; p=.001). Conclusion This preliminary analysis of total cost of treatment data showed that among CML patients treated with a second line TKIs, those treated with dasatinib were associated with higher total healthcare costs and more frequent health care resource utilization than patients treated with nilotinib. Results may be updated when more data on nilotinib patients becomes available. Disclosures: Wu: Novartis: Consultancy, I am working for Analysis Group Inc and Analysis Group Inc received funds from Novartis to conduct the analysis. Bollu:Novartis Oncology: Employment. Guo:Novartis Pharmaceuticals Corporation: Employment. Guerin:Novartis: Consultancy, I am working for Analysis Group Inc and Analysis Group Inc received funds from Novartis to conduct the analysis. Tsaneva:Novartis: Consultancy, I am working for Analysis Group Inc and Analysis Group Inc received funds from Novartis to conduct the analysis. Williams:Novartis Pharmaceutical Corporation: Employment. Griffin:Novartis Pharmaceutical Corporation: Consultancy, I have.

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