Post-infusion Costs Associated with Idecabtagene Vicleucel Treatment for Patients with Relapsed/Refractory Multiple Myeloma in the KarMMa Trial

INTRODUCTION

Patients with triple-class exposed relapsed/refractory multiple myeloma (RRMM) have poor outcomes with substantial healthcare costs. Idecabtagene vicleucel (ide-cel), a B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T cell therapy, showed deep, durable responses in patients with RRMM in the pivotal phase 2 KarMMa trial (NCT03361748). Healthcare resource utilization (HCRU) and costs were estimated for ide-cel-treated patients in the KarMMa trial.

METHODS

Post-infusion costs were estimated based on HCRU data, including facility care, diagnostics, medications, and procedures. Length of stay (LOS) was extracted for inpatient and intensive care unit (ICU) care. All patients had a 14-day post-infusion inpatient stay per trial protocol. Analyses were conducted for patients treated in the United States (US), who received the ide-cel target dose of 450 × 106 CAR + T cells and assuming a 7-day inpatient stay.

RESULTS

Overall, 128 patients received ide-cel and were included in this analysis. Mean age was 60 years, 59% were men, and 81% were white. Mean total LOS was 23.9 days. Total estimated costs over 24 months post-infusion were US$115,614 per patient, driven by facility costs (75%; $86,385). Most costs were incurred in the first month (58%; $67,259). The scenario analysis assuming a 7-day inpatient stay showed estimated 24-month costs of $92,294. For the 54 (42%) patients who received ide-cel high dose, total costs over 24 months were $113,298 per patient.

CONCLUSIONS

Extrapolation of costs based on HCRU data from patients receiving single-infusion of ide-cel in the KarMMa trial showed substantially reduced HCRU and costs over 2 years after initial treatment. Most costs were incurred during the first month after ide-cel infusion, likely attributable to the 14-day inpatient stay required by the trial protocol. These findings suggest a nominal, incremental monthly cost of care immediately after treatment, which may be lower in routine clinical practice.

Real-world switch patterns and healthcare costs in biologic-naive psoriasis patients initiating apremilast or biologics

Aim: Treatment switching and healthcare costs were compared among biologic-naive psoriasis patients initiating apremilast or biologics with ≥12 months pre-/post-index continuous enrollment in Optum Clinformatics™ Data Mart. Methods: After propensity score matching, switch rates (new therapy post-index) and days between index and switch were assessed. Total and per-patient per-month costs by service type were assessed. Results: Apremilast initiators (n = 533) were matched and compared with biologic initiators (n = 955). Twelve-month cumulative switch rates and days to switch were similar. Apremilast initiators had significantly lower total healthcare costs than biologic initiators; apremilast switchers and nonswitchers had significantly lower per-patient per-month costs than biologic switchers and nonswitchers, driven mainly by reduced outpatient pharmacy costs. Conclusion: Apremilast initiators had lower healthcare costs even with treatment switching.

Treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriatic arthritis: results from a US claims analysis

Objective: Information on treatment costs for psoriatic arthritis (PsA) can be valuable for payers and providers who make treatment and formulary decisions. This study compared real-world treatment patterns and healthcare costs among biologic-naive patients with PsA initiating apremilast or biologics.Methods: A retrospective cohort study was conducted using the Optum Clinformatics™ claims database. The study included biologic-naive patients with PsA who initiated treatment with apremilast or a biologic between 1 January 2014, and 31 December 2015. Propensity score matching was used to adjust for selection bias. Treatment persistence/adherence and all-cause healthcare costs were evaluated. Cost differences were determined using Wilcoxon rank-sum tests.Results: In all, 125 biologic-naive patients initiating treatment with apremilast were matched to 245 biologic-naive patients initiating treatment with a biologic. Twelve-month treatment persistence was similar for apremilast vs. biologic users (43.2 vs. 36.7%; p = .2277). While persistent on treatment for up to 12 months, total healthcare costs (from all utilizations) were significantly lower among apremilast vs. biologic users ($28,130 vs. $37,093; p < .0001). Likewise, per-patient per-month costs while persistent on treatment were significantly lower among apremilast vs. biologic users whether they switched treatments ($2,455 vs. $3,497; p = .0103), remained persistent on treatment ($2,434 vs. $3,521; p < .0001), or discontinued but did not switch treatments ($2,178 vs. $2,696; p = .0082).Conclusions: Apremilast patients had significantly lower healthcare costs than biologic patients, even when they switched to a biologic, during the 12-month post-index period. These results may be useful to payers and providers seeking to optimize PsA care while reducing healthcare costs.

Lenalidomide maintenance post-transplantation in newly diagnosed multiple myeloma: real-world outcomes and costs

Aim: To compare real-world outcomes and costs among patients with newly diagnosed multiple myeloma receiving lenalidomide-only maintenance (Len-Mt) versus no maintenance after autologous hematopoietic stem cell transplantation. Patients & methods: Time to next treatment (TTNT) was evaluated; costs were calculated for 0–12, 12–24 and 24–36 months postindex date. Results: Len-Mt cohort had longer TTNT (HR: 0.43; p < 0.0001). Per-patient per-month costs during months 0–12 were higher among patients, receiving Len-Mt (USD 13,095 vs USD 8910; p < 0.0001), due to higher pharmacy costs – outpatient costs were lower. During months 12–24 and 24–36, outpatient costs were similar in both cohorts; total and pharmacy costs remained elevated for patients receiving Len-Mt. Conclusion: Len-Mt improved TTNT, initially reduced outpatient costs, but resulted in higher overall and pharmacy costs.

Real-world treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriasis

OBJECTIVE

This study compared real-world treatment patterns and healthcare costs among biologic-naive psoriasis patients initiating apremilast or biologics.

METHODS

A retrospective cohort study was conducted using the Optum Clinformatics™ claims database. Patients with psoriasis were selected if they had initiated apremilast or biologics between January 1, 2014, and December 31, 2015; had 12 months of pre-index and post-index continuous enrollment in the database; and were biologic-naive. The index date was defined as the date of the first claim for apremilast or biologic, and occurred between January 1, 2014, and December 31, 2015. Treatment persistence was defined as continuous treatment without a > 60-day gap in therapy (discontinuation) or a switch to a different psoriasis treatment during the 12-month post-index period. Adherence was defined as a medication possession ratio (MPR) of ≥ 80% while persistent on the index treatment. Persistence-based MPR was defined as the number of days with the medication on hand measured during the patients' period of treatment persistence divided by the duration of the period of treatment persistence. Because patients were not randomized, apremilast patients were propensity score matched up to 1:2 to biologic patients to adjust for possible selection bias. Treatment persistence/adherence and all-cause healthcare costs were evaluated. Cost differences were determined using Wilcoxon rank-sum tests.

RESULTS

In all, 343 biologic-naive patients initiating apremilast were matched to 680 biologic-naive patients initiating biologics. After matching, patient characteristics were similar between cohorts. Twelve-month treatment persistence was similar for biologic-naive patients initiating apremilast vs biologics (32.1% vs 33.2%; p = 0.7079). While persistent on therapy up to 12 months, per-patient per-month (PPPM) total healthcare costs were significantly lower among biologic-naive cohorts initiating apremilast vs biologics ($2,214 vs $5,184; p < 0.0001). Likewise, PPPM costs while persistent on therapy were significantly lower among patients initiating apremilast vs biologics, whether they switched treatments ($2,475 vs $4,422; p < 0.0001), remained persistent ($2,279 vs $3,883; p < 0.0001), or discontinued but did not switch treatments ($2,104 vs $6,294; p < 0.0001).

LIMITATIONS

Data were limited to individuals with United Healthcare commercial and Medicare Advantage insurance plans, and may not be generalizable to psoriasis patients with other insurance or without health insurance coverage.

CONCLUSION

Biologic-naive patients with similar patient characteristics receiving apremilast vs biologics had significantly lower PPPM costs, even when they switched to biologics during the 12-month post-index period. These results may be useful to payers and providers seeking to optimize psoriasis care while reducing healthcare costs.

Performance-Based Risk-Sharing Arrangements: U.S. Payer Experience

BACKGROUND

As a result of global concern about rising drug costs, many U.S. payers and European agencies such as the National Health Service have partnered with pharmaceutical companies in performance-based risk-sharing arrangements (PBRSAs) by which manufacturers share financial risk with health care purchasing entities and authorities. However, PBRSAs present many administrative and legal challenges that have minimized successful contract experiences in the United States.

OBJECTIVE

To (a) identify drug and disease characteristics and contract components that contribute to successful PBRSA experiences and the primary barriers to PBRSA execution and (b) explore solutions to facilitate contract negotiation and execution.

METHODS

A 37-item, web-based survey instrument (Qualtrics), approximately 20 minutes in duration, was open during July and August 2016. The survey was emailed to 90 pharmacy and medical directors of various health care organizations. Statistical analysis included the Kruskal-Wallis test and chi-square tests to examine differences among payer responses. Survey responses were anonymized and data were aggregated.

RESULTS

Twenty-seven individuals completed the survey (30% completion rate). The majority of respondents worked for regional health plans (52%, n = 14), covering at least 1 million lives (63%, n = 17), with at least 7 years of managed care experience (81%, n = 22). A total of 51 PBRSAs were active among respondents at the time of the survey. Easily obtainable and evaluable drug data and medical data were the most important drug and disease attributes for successful PBRSAs, respectively. Pharmacy claims and patient demographic data were assessed as "very easy and inexpensive" to collect. Type and amount of manufacturer payment for drug outcome performance failure, endpoint measurement, and necessary clinical data for drug performance measurement were all critical factors for successful PBRSAs. Standardized contract templates and transparent contract financial risk evaluation and modeling ranked highest among methods of manufacturer facilitation of PBRSAs. This study was limited by sample size and survey questions were limited to explanation of PBRSAs at the disease state level.

CONCLUSIONS

On the basis of PBRSA experiences, respondents noted that drug use in chronic medical conditions and objective drug outcome performance measurements were favorable drug characteristics and serve as the primary source of satisfaction for these types of contracts. Third parties and manufacturers can facilitate the uptake and success of PBRSAs by developing standardized contracting templates in addition to other methods that increase their stake in the arrangement. Looking forward, mounting perceptions of success in this realm of contracting for pharmaceuticals may contribute in the quest for value-based payments in the U.S. health care system.

DISCLOSURES

The construction of the survey and payment for survey respondents were supported by Charles River Associates. Parece is an employee of Charles River Associates. Goble and Ung are completing fellowship training sponsored by Novartis and Celgene, respectively, but do not have any conflicts of interest and did not receive any funding related to this study. Navarro reports consulting fees from Analysis Group, TEVA, and Amgen, unrelated to this study. Van Boemmel-Wegmann declares no conflict of interest. Study concept and design were contributed by Navarro, Goble, Ung, and Parece. Navarro took the lead in data collection, along with Goble and Ung, and data interpretation was performed by van Boemmel-Wegmann, Goble, and Ung. The manuscript was written by Goble, Ung, Navarro, and van Boemmel-Wegmann and revised by all of the authors.

Comparative effectiveness of nab-paclitaxel plus gemcitabine versus FOLFIRINOX in metastatic pancreatic cancer: A nationwide chart review in the United States

376

Background: nab-Paclitaxel plus gemcitabine ( nab-P+G) and FOLFIRINOX (FFX) are among the most common first-line (1L) therapies for metastatic adenocarcinoma of the pancreas (mPC), yet there is no head-to-head trial comparing their efficacy and real-world data is limited. As new second-line (2L) therapies become available, it is important to understand the real-world effectiveness associated with different treatment sequences. Methods: This retrospective cohort study compared the efficacy and safety of 1L nab-P+G vs. FFX, overall and under specific treatment sequences. Medical records were reviewed by 215 physicians across the US who provided information for mPC patients who initiated 1L with nab-P+G or FFX between 04/01/2015-12/31/2015. The outcomes of interest were overall survival (OS) and tolerability. OS was evaluated using Kaplan-Meier curves, and compared between cohorts using Cox proportional hazards model adjusting for baseline characteristics. Results: Medical records were reviewed for 654 patients receiving nab-P+G (n = 337) or FFX (n = 317) as 1L therapy for mPC. Patients in the nab-P+G cohort were older, less likely to have ECOG ≤ 1 and had more comorbidities than patients in the FFX cohort. There was no statistically significant difference in OS (adjusted HR = 0.99, p = 0.96), with median OS (mOS) being 12.1 and 13.8 months for nab-P+G and FFX, respectively. Among the subgroup of patients with ECOG ≤ 1, mOS was 14.1 and 13.7 months, respectively (adjusted HR = 1.00, p = 0.99). Among patients with 1L nab-P+G and FFX, 36.1% and 41.3% received 2L therapy and experienced mOS of 16.3 and 16.6 months, respectively (HR = 1.04, p = 0.76). Among commonly observed adverse events (AEs) (≥ 5% of patients in both cohorts), the rates of diarrhea, fatigue, mucositis, nausea and vomiting were higher in the FFX than nab-P+G cohort (all p < 0.05). Conclusions: In a nationwide sample of mPC patients, real-world survival outcomes were similar between patients receiving 1L nab-P+G or FFX. both overall and among patients who went on to receive active 2L treatments. In addition, nab-P+G was associated with significantly lower rates of common AEs compared with FFX.

Assessing the Effect of Adherence on Patient-reported Outcomes and Out of Pocket Costs Among Patients With Multiple Myeloma

BACKGROUND

The present study characterized the effect of multiple myeloma (MM) on work productivity, health care resource usage, and out of pocket costs (OOPCs) and examined the association of adherence with quality of life (QoL) and productivity loss.

MATERIALS AND METHODS

The present cross-sectional study included 162 patients categorized by their 4-item Morisky Medication Adherence Scale (MMAS-4) score (4 vs. ≤ 3). Online surveys included the Work Productivity and Activity Impairment questionnaire, Functional Assessment of Cancer Therapy-Multiple Myeloma (FACT-MM), and MM-specific questions.

RESULTS

On average, patients reported FACT-MM scores of 98.5 ± 29.3, absenteeism of 18.3% ± 17.8%, presenteeism of 51.8% ± 30.2%, overall work productivity impairment of 57.3% ± 31.7%, and activity impairment of 49.9% ± 29.5% in the previous 7 days. During the previous 3 months, the mean OOPCs were $709 ± $1307; prescription medications accounted for 55% of these costs. Patients attended 4.1 ± 4.6 visits to oncologists or hematologists during that time, which accounted for 45% of the OOPCs. Patients spent an average of 6.8 ± 8.3 hours at MM-related monthly appointments, and 35.2% reported frustration while at the doctor's office. Patients with an MMAS-4 score of 4 reported higher FACT-MM scores (106.9 vs. 89.2; P < .001). Patients with an MMAS-4 score of ≤ 3 reported greater activity impairment (56.5% vs. 39.8%; P = .015) and feeling overwhelmed or frustrated with rescheduling MM appointments (64.0% vs. 26.0%; P = .002).

CONCLUSION

MM was associated with significant workplace and functional impairment, high OOPCs, and frequent office visits. High medication adherence was associated with better outcomes across these domains. As survival for patients with MM improves, patient QoL should be considered to enhance these outcomes.

Adherence, quality of life, health care resource use, and functional impairment among patients with oral multiple myeloma (MM) treatments

e19519

Background: Few studies have assessed the relationship between adherence to prescribed therapies and patient (Pt)-reported outcomes (PRO) in Multiple Myeloma (MM). Pt-reported adherence and its association with quality of life (QoL), healthcare resource use (HRU) and functional impairment among pts on oral MM treatments were assessed. Methods: This was a cross-sectional survey of 118 US adult MM pts identified from the Light Speed Research panel, who were currently on a regimen which included an oral therapy. Pt’s experiences using the Morisky Medication Adherence Scale-4 (MMAS-4), the Work Productivity and Activity Impairment, and the Functional Assessment of Cancer Therapy (FACT)-MM were examined. Higher FACT-MM scores indicated better health-related QoL. Pts were characterized by their MMAS score; score =4 and score ≤3 (max score =4). Pts in each score grouping were summarized based on pt characteristics, treatment history, HRU and PROs. Multivariable analyses estimated the association between MMAS score group and study outcomes. Results: A total of 72 (61%) pts reported a MMAS score = 4 and 46 (39%) pts had a score ≤3. Pts with a score =4 were older (59.2 vs 50.7 years; p<0.001) and were on fewer treatments (1.42 vs 2.13; p<0.001) than with a score ≤3. No differences in race/ethnicity, marital status, income or education level were noted between the two groups. Pts with a score ≤3 had higher levels of absenteeism, impairment while at work (presenteeism), and overall work impairment in descriptive analysis, but only differences in activity impairment (56.5% vs. 39.8%; p=0.015) remained significant in the multivariable analyses. Pts with a score = 4 reported higher FACT-MM scores (106.9 vs 89.2; p<0.001) than pts with a score ≤3, a trend seen in all FACT-MM subscores. More pts with a score ≤3 also reported being overwhelmed or frustrated by having to reschedule MM appointments (64% vs. 26%; p=0.002). Conclusions: Among MM pts on oral treatments, high adherence is associated with improved QoL and a lower level of activity impairment. There may also be a relationship between frustration in managing MM related appointments and levels of adherence.

Total healthcare, treatment, and supportive care costs among metastatic pancreatic cancer (MPC) patients (pts) treated with either nab-paclitaxel/gemcitabine (nab-P+G) or FOLFIRINOX (FFX) in the first-line (1L) setting

20

Background: The economic burden of MPC is substantial while treatment options are limited. This study compared treatment, supportive care, and total health care costs in MPC pts who initiated nab-P+G or FFX in a large insured US population. Methods: A retrospective study was conducted using claims from the Clinformatics Data Mart Database. Adults who had ≥2 claims for PC, ≥1 claim with a secondary malignancy, completed >1 cycle of nab-P+G or FFX as 1L between 1/1/2013 and 12/31/2015, and had continuous enrollment in health plans for ≥6 months prior to and 3 months following the start of 1L, were selected. Total health care costs and MPC-related treatment costs were measured per patient per month (PPPM) during 1L. Results: 216 MPC pts met selection criteria ( nab-P+G, n=139; FFX, n=77). Pts on nab-P+G were significantly older (mean age: 67.6 vs. 61.4 years; p<0.001) vs. FFX. nab-P+G pts incurred similar total health care costs but less supportive care and treatment administration costs vs. FFX (table). The nab-P+G group had a significantly lower proportion of pts who received peg-filgrastim (13.7% vs. 50.6%; p<0.001); with lower PPPM number of fills (0.11 vs. 0.71; p<0.001), anti-emetics (92.8% vs. 100%; p=0.0154), and hydration procedures (63.3% vs. 98.7%; p=0.0001), but a higher proportion received oral opioids (66.2% vs. 54.5%, p=0.0066) during 1L. Conclusions: Total health care costs were similar. nab-P+G pts had higher chemotherapy drug costs while FFX pts had higher treatment administration and supportive care costs. [Table: see text]

Few-mode fiber with inverse-parabolic graded-index profile for transmission of OAM-carrying modes

A novel type of few-mode fiber, characterized by an inverse-parabolic graded-index profile, is proposed for the robust transmission of cylindrical vector modes as well as modes carrying quantized orbital angular momentum (OAM). Large effective index separations between vector modes (>2.1 × 10(-4)) are numerically calculated and experimentally confirmed in this fiber over the whole C-band, enabling transmission of OAM(+/-1,1) modes for distances up to 1.1 km. Simple design rules are provided for the optimization of the fiber parameters.

Characterization of OAM fibers using fiber Bragg gratings

The reflectogram of a fiber grating is used to characterize vector modes of an optical fiber supporting orbital angular momentum states. All modes, with a minimal effective index separation around 10(-4), are simultaneously measured. OAM states are reflected by the FBG, along with a charge inversion, at the center wavelength of the Bragg reflection peak of the corresponding fiber vector mode.

In vitro bacterial penetration of coronally unsealed endodontically treated teeth

Forty-five root canals were cleaned, shaped, and then obturated with gutta-percha and root canal sealer, using a lateral condensation technique. The coronal portions of the root filling materials were placed in contact with Staphylococcus epidermidis and Proteus vulgaris. The number of days required for these bacteria to penetrate the entire root canals was determined. Over 50% of the root canals were completely contaminated after 19-day exposure to S. epidermidis. Fifty percent of the root canals were also totally contaminated when the coronal surfaces of their fillings were exposed to P. vulgaris for 42 days.