Treatment patterns and healthcare costs among newly-diagnosed patients with chronic myeloid leukemia receiving dasatinib or nilotinib as first-line therapy in the United States

OBJECTIVE:

To compare treatment patterns and economic outcomes of dasatinib and nilotinib as 1st-line therapies for chronic myeloid leukemia (CML).

METHODS:

Adult CML patients initiated on first-line dasatinib or nilotinib in 2010-2014 were identified from two large US administrative claims databases. Treatment patterns, tyrosine kinase inhibitor (TKI) adherence and healthcare resource utilization (HRU) and costs were measured from the 1st-line TKI initiation (index date) to the end of follow-up.

RESULTS:

A total of 604 and 418 patients were included in the dasatinib and nilotinib cohorts (mean ages = 50.9 and 52.5 years, 46.4% and 45.7% female), respectively. Among the dasatinib patients, 91% started with 100 mg/day, 3% with <100 mg day, and 6% with>100 mg/day. Among the nilotinib patients, 76% started with 600 mg/day, 16% with >600 mg/day, and 8% <600 mg day. the dasatinib cohort had a higher hazard of dose decrease (hazard ratio [hr] =" 1.66;" p =" .002)" and of switching to another tki (hr="1.62;" p =" .019)" compared to the nilotinibcohort. the hazard of dose increase (hr="0.76;" p =" .423)" and treatment discontinuation (hr="1.10;" p =" .372)" were not significantly different between cohorts. there was also no significant difference in tki adherence levels (mean proportion of days covered [pdc] difference over first 6 months="-0.0003," p =" .981;" mean pdc difference over first 12 months="-0.0022," p =" .880)" and hru (inpatient day incidence rate ratio [irr] =" 1.03," p =" .930;" emergency room irr="1.26," p =" .197;" and days with outpatient services irr="1.01," p =" .842)." the dasatinib cohort incurred higher healthcare costs by $749 per patient per month (p =" .044)" compared to the nilotinib cohort.>

LIMITATION:

Information on CML phase and Sokal score was not available.

CONCLUSIONS:

Dasatinib was associated with an increased hazard of dose decrease and switching to another TKI and higher healthcare costs, vs nilotinib.