Cost burden of first-line antineoplastic treatment failure in patients with chronic lymphocytic leukemia.
Bibliographic record
Abstract
e19037 Background: Treatment failure (TF) is associated with significant cost burden in patients with non-Hodgkin’s lymphoma (NHL) in the US. This study assessed treatment patterns and healthcare cost burden of first-line (FL) TF in patients with chronic lymphocytic leukemia (CLL), a subtype of NHL, overall, and for the top 5 FL regimens. Methods: A retrospective study of a large national claims database identified adult patients with CLL who initiated an antineoplastic agent (AA) after their first CLL diagnosis (index date) from 01/2011- 07/2016. Patients included had ≥12 and ≥6 months of observation pre- and post-index, respectively, and were treatment-naïve with no solid or selected blood malignancies in the pre-index period. FL therapy included AA administered within the first 30 days post-index. TF occurred at the earliest of: initiation of a new AA, resumption of initial treatment following a gap of ≥3 months, radiotherapy, stem cell transplant, or hospice care. The total cost difference between patients with and without FL TF was estimated using ordinary least squares regressions adjusted for baseline characteristics. Non-parametric bootstrap was used to estimate confidence intervals (CI) and p-values. Results: Among the 2,226 patients included (mean age: 68 years; female: 41%), 46% experienced FL TF. Overall, the average adjusted total cost difference between patients with and without FL TF was $3,011 per patient per month (PPPM) (95% CI: 2,400, 3,583; P < 0.001). Among the 5 most common FL regimens, fludarabine / cyclophosphamide / rituximab (FCR) regimen was associated with the highest PPPM cost of TF (N = 281; $4,758; 95% CI: 2,652, 7,346), followed by other cyclophosphamide-based regimens (N = 142; $4,579; 95% CI: 2,474, 6,311), chlorambucil-based regimens (N = 223; $3,761; 95% CI: 2,029, 5,602), bendamustine / rituximab (BR) regimen (N = 592; $3,163; 95% CI: 2,206, 4,148), and other rituximab-based regimens (N = 474; $3,030; 95% CI: 2,164, 3,956) (P < 0.001 for all). Conclusions: The most common FL regimens used in patients with CLL were associated with 46% treatment failure. Clinicians should consider the cost of treatment failure when selecting the initial therapy in these patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".