A Retrospective Observational Study of Annual Healthcare Costs for Patients with Forms of Myeloproliferative Neoplasms (MPN)

Three subtypes of MPN (myelofibrosis (MF), polycythemia vera (PV) and essential thrombocythemia (ET)) are characterized by activation of JAK2 signaling, with the majority having the JAK2 V617F mutation. Median survival in these subtypes ranges from months to years for MF (Gangat JCO 2011) and up to a decade or more for some patients with PV and ET. Some symptomatic treatment options exist, but with the exception of hematopoietic stem cell transplant, none are curative. Little is known about healthcare costs associated with these diseases.

To compare annual medical and pharmacy costs in three subtypes of MPN patients (MF, PV, ET) to matched non-cancer controls using a large US commercial claims database.

Data were drawn from the Thomson Reuters MarketScan database, which contains claims for insured employees, retirees and dependents from approximately 100 US payers. Index date was the first claim with an MPN diagnosis code in the time period 2005 to 2008. Eligible patients had one year continuous enrollment post-index with no evidence of non-AML secondary malignancy. Controls had one year of continuous enrollment after their match date and were matched to patients in a ratio of 5:1 based on gender, year of birth, geographic region and insurance type (Comprehensive, Health Maintenance Organization, Preferred Provider Organization, etc.). Controls were excluded if they had a service claim with a diagnosis for cancer or a pharmacy claim for chemotherapy. Costs were based on total gross payments to the provider, which equals the amount eligible for payment under the medical plan terms after applying rules for discounts, but before applying coordination of benefits, copayments and deductibles. Total cost was the sum of MPN and non-MPN related medical costs which included inpatient, outpatient and emergency room service and pharmacy. Pharmacy included injectable and non-injectable chemotherapy, supportive care and other prescription drug costs.

A total of 25,145 MPN patients (MF: 509, PV: 16,165, ET: 8,471) were included and assigned matching controls. The mean cost (standard deviation) for cases and controls are shown in the table.

Medical and Pharmacy Costs:

Annual medical and pharmaceutical costs for patients with MPNs are 2 to 6 times those of matched non-cancer patients and represent medical management challenges and payer burden. Outpatient visits accounted for about half of the total healthcare costs, followed by inpatient visits, pharmaceutical costs and ER visits.

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