Time and Cost of Hospitalisation for Salvage Therapy in Adults with Philadelphia Chromosome-Negative B Cell Precursor Relapsed or Refractory Acute Lymphoblastic Leukaemia in Spain

Abstract

Background Philadelphia chromosome-negative (Ph−) relapsed or refractory (R/R) B-cell precursor acute lymphoblastic leukaemia (ALL) is rare, and information on its impact on healthcare systems is scarce. Objective To quantify the time and reimbursement associated with hospitalisations of patients with R/R ALL in a Spanish hospital. Methods Retrospective review of medical charts identified patients aged ≥ 18 years with Ph− R/R ALL hospitalised between 1998 and 2014. Data were collected from the date of first diagnosis of R/R ALL (index) until death or loss to follow-up. The primary endpoint was the proportion of time hospitalised during chemotherapy. Reimbursement associated with hospitalisations (including associated chemotherapy) was also assessed. Results Thirty-two patients were eligible for inclusion. Their median age was 41 years, and 50% had a first remission duration of ≤ 1 year; 34% had undergone allogeneic haematological stem-cell transplantation (alloHSCT). Overall, 31 patients had received intensive salvage chemotherapy, during which there were 42 hospitalisations (mean 1.4/patient; mean duration 26 days). Patients spent a mean of 71% of the chemotherapy period in hospital. Total mean reimbursement was €26,417 per patient, almost all (€25,723) attributable to inpatient stays (€18,986/hospitalisation). From the index date to death or loss to follow-up (excluding alloHSCT-related hospitalisations), there were 80 hospitalisations (mean duration 24 days); mean reimbursement was €16,692 per hospitalisation and €41,730 per patient. AlloHSCT ( n = 8) involved 18 hospitalisations (mean reimbursement €39,782/hospitalisation; €89,510/patient). Conclusion Data from this sample of patients suggest that hospitalisations in R/R ALL are lengthy and associated with high costs in Spain.

Healthcare resource utilization in adult patients with relapsed/refractory FLT3 mutated acute myeloid leukemia: A retrospective chart review from Spain

“…In addition, HCRU and associate costs were calculated separately for the first, second, and third or beyond R/R episode. For this purpose, data of each R/R episode were collected from each R/R episode date until next R/R episode, death, or last follow‐up without relapse, whichever occurred first 7 . Moreover, we analyzed HCRU and overall cost in patients with early relapse/primary refractory AML vs >6 months of first CR (CR1) duration.…”

“…The list provides information on the healthcare costs reimbursed to the hospital and the average length of stay for each DRG code. Reimbursement for chemotherapy does not need to be added to the reimbursed costs because it is considered to be included in the reimbursement for the assigned DRG code 7 . Reimbursement followed the algorithm for hematologic hospitalizations at the center.…”

“…For patients who underwent alloHSCT after the index date, alloHSCT period was defined as the time from starting conditioning alloHSCT to death or last follow‐up. The exposure period of each R/R episode was calculated as time between the day of first R/R episode (index date) until the date of next relapse or death/last follow‐up without relapse, whichever occurs first 7 …”

“…The exposure period of each R/R episode was calculated as time between the day of first R/R episode (index date) until the date of next relapse or death/last follow-up without relapse, whichever occurs first. 7 In addition, HCRU and associate costs were calculated separately for the first, second, and third or beyond R/R episode. For this purpose, data of each R/R episode were collected from each R/R episode date until next R/R episode, death, or last follow-up without relapse, whichever occurred first.…”

“…Reimbursement for chemotherapy does not need to be added to the reimbursed costs because it is considered to be included in the reimbursement for the assigned DRG code. 7 Reimbursement followed the algorithm for hematologic hospitalizations at the center. The reimbursement for outpatient care was €108 for each outpatient visit and €269 for each day's stay at a day hospital (€691 each day's stay at a day hospital after alloHSCT); these values were based on the mean day hospital unit costs calculated using costs from all Spanish regions.…”