Health care utilization and risk of infection and bleeding among patients with myelodysplastic syndromes with/without transfusions, and with/without active therapy

Abstract

This study utilized claims data from a national US commercial health insurer to examine rates of cytopenia-related complications (significant bleeding, infection) and health care utilization (emergency room visits, inpatient hospitalizations) among patients with myelodysplastic syndromes (MDS) within predefined periods of transfusion activity and active therapy. Periods with no transfusions, regardless of relationship to treatment intervention, were associated with lower rates of cytopenia-related complications. These data suggest that eliminating or reducing the need for transfusions may help to reduce MDS-related medical problems, and treatment toward that goal should be considered in patients with MDS needing transfusions.

Economic Burden of Patients Treated for Higher-Risk Myelodysplastic Syndromes (HR-MDS) in Routine Clinical Care in the United States

“…A longitudinal analysis of elderly MDS patients utilizing the SEER database found that the 2-year cost from MDS diagnosis was higher in patients treated with HMAs versus those who did not receive HMAs [$92,102 vs $40,111, respectively (2009 US dollars)] [ 6 ]. Additionally, a retrospective analysis reviewing the use of transfusions and/or active therapy in MDS patients showed that patients were at highest risk for hospitalization when receiving both transfusions and active therapy [ 8 ]. However, neither of these previous studies accounted for IPSS-R risk category.…”

“…However, HMAs have demonstrated the ability to significantly reduce the transfusion burden in this patient population, which is also a substantial medical cost for patients with MDS [ 2 , 7 ]. In fact, another retrospective claims analysis demonstrated that patients with MDS have a higher risk of emergency department (ED) visits and inpatient admissions during periods of follow-up when transfusions are administered versus during transfusion-free periods [ 8 ]. Both of the HMAs (i.e., azacitidine and decitabine) have been shown to be cost-effective options for the treatment of patients with HR-MDS, but azacitidine has been shown to be more cost-effective than decitabine in a recent analysis [ 9 , 10 ].…”

Infection control in patients with myelodysplastic syndromes who are candidates for active treatment: Expert panel consensus-based recommendations

“…Frailty, chronic infections or previous severe infectious episodes, environmental (home, hospital), and patients' (airways) bacterial or fungal colonizations, iron overload (IO), bone marrow reserve (cytopenias) and biological status of the disease (number of blasts and genetic characteristics), have all been variably associated with an increased risk of infections and with their severity [4][5][6]29,34,[36][37][38].…”

Incidence and Burden of the Myelodysplastic Syndromes

“…More recently, a retrospective claims review was performed using the Optum Research Database (2007–2009), which includes medical and pharmacy claims and eligibility information from a national US health plan [ 41 •]. Of 4351 patients with MDS identified, 1105 received ≥1 transfusion, and transfusions were associated with higher risk of infection, bleeding events, hospitalizations, and emergency room visits.…”

“…In patients that had transfusions, the risks of infection or bleeding events were similar whether or not they had active therapy. Surprisingly, most patients ( n = 886) receiving transfusions were not receiving active therapies [ 41 •], although active therapies such as azacitidine and lenalidomide have been shown to significantly reduce RBC transfusion burden [ 42 , 43 ]. A study of lenalidomide asserted that this reduction extends to cost burden—as the cost of lenalidomide treatment was more than offset by the savings related to reductions in TD and the associated complications [ 44 ].…”