Significant Cost of Treating Myeloproliferative Neoplasms

Neil Canavan

February 2012, Vol 3, No 1 - ASH Annual Meeting


A new cost analysis of the management of the 3 subtypes of myeloproliferative neoplasms (MPNs)—myelofibrosis, poly­cythemia vera, and essential thrombocythemia—shows that associated medical and pharmaceutical expenses for patients with these hematologic disorders in patients with cancer are 2 to 6 times that of matched patients without cancer. Outpatient visits for MPN accounted for more than 50% of the total costs incurred by patients with cancer.

“Some symptomatic treatment op­tions exist, but with the exception of hematopoietic stem-cell transplant, none are curative. And little is known about healthcare costs associated with these diseases,” according to Gregory L. Price, MPH, who presented the data at ASH 2011.

The median survival in these MPN subtypes ranges from months to years for myelofibrosis, and as long as a decade or more for patients with polycythemia vera and essential thrombocythemia.

To perform this cost analysis, data for the years 2005-2008 were extracted from the Thomson Reuters MarketScan database, which includes claims data from more than 100 US payers. Patients eligible for analysis had to have an MPN diagnosis code for the study period.

Data on matched patients with no cancer (ie, the control group) were selected based on sex, year of birth, geographic region, and insurance type. Calculated costs were based on total gross payments to the provider.

Total costs were defined as the sum of MPN- and non–MPN-related medical costs, including inpatient, out­patient, and emergency department services and pharmacy. Costs related to pharmacy included chemotherapy (injectable and otherwise) and other prescription supportive care.

Table
Mean Costs for MPNs: Patients with Cancer versus Controls
View larger version

A total of 25,145 patients with MPN were included in the analysis. As expected, all MPN-related costs for the parameters selected exceeded those of noncancer controls. Results for outpatient care cost, pharmaceutical cost, and total cost are highlighted in the Table.

In November 2011, ruxolitinib (Jakafi), a Janus kinase (JAK) inhibitor, was the first drug to be approved by the US Food and Drug Administration for myelofibrosis and related diseases. New JAK inhibitors are currently in development.

LY2784544, a JAK2 inhibitor, is currently in phase 1 clinical trials. Pre­liminary data for the current 19 patients enrolled have been presented at the meeting.