(225) Treatment Patterns, Healthcare Resource Utilization (HCRU), and Costs in Adolescent and Young Adult (AYA) Patients (Pts) With Acute Lymphoblastic Leukemia (ALL)

Background: : The treatment (Tx) landscape for ALL has evolved significantly over the past decade with protocol updates and newer therapies. Asparaginase (ASP)-containing pediatric-inspired regimens (PIRs) have shown improved survival and decreased relapse rates over conventional cytotoxic regimens such as hyper-CVAD. However, ASP-containing PIRs are not widely adopted despite guideline recommendations.

Objective: : To examine Tx patterns, HCRU, and costs for AYA pts with newly diagnosed ALL in the US.

Methods: : This retrospective descriptive analysis used the Optum deidentified Market Clarity claims and electronic heath records database from Jul 2018-Dec 2023. Index date (ID) was defined as the earliest non-diagnostic medical claim for ALL. Pts were followed until earliest of disenrollment/end of study (min 3 months) or death. Eligible pts aged 15-39 years had ≥2 non-diagnostic claims for ALL on separate days, with continuous enrollment and without another primary cancer or pregnancy in a 6-month baseline (prior to ID) and follow-up period, without any history of oncology medication or ALL diagnosis prior to ID, and initiated Tx ≤60 days of ID.

Results: : Pts (N=157) received ASP (n=43), hyper-CVAD (n=29), nelarabine (n=8), regimens without core components of a PIR (non-PIR, n=55), or other regimens (n=22). Mean follow-up duration was ~2 years. Pt characteristics were similar across groups (overall median age 19 years; 66% male) except for age and sex of hyper-CVAD–treated pts. Median (IQR) time from diagnosis to Tx was 22 (10-34), 29 (15-40), 17 (13-24), 15 (11-25), and 17 (9-34) days overall, with ASP, hyper-CVAD, nelarabine, and non-PIR regimens, respectively. Most pts (>90%) were admitted to the ER and/or had ≥1 inpatient stay during follow-up. Per-pt per-month (PPPM) number of visits (mean [SD]) were similar across Txs; ASP-treated pts had fewer PPPM inpatient days (2.9 [3.4]) vs the other 3 cohorts (hyper-CVAD, 4.0 [3.9]; nelarabine, 3.7 [3.7]; non-PIR regimens, 5.4 [7.3]). PPPM total all-cause costs (mean [SD]) were lowest with ASP regimens ($44381 [28456]) and highest with nelarabine ($86270 [67338]). PPPM pharmacy costs (mean [SD]) were higher with ASP ($1940 [5073]) and nelarabine ($1928 [4141]) compared with hyper-CVAD ($1506 [2623]) and non-PIR regimens ($1426 [2824]).

Conclusions: : In this descriptive analysis, we observed < 30% of pts receiving ASP regimens despite guideline recommendations and survival benefits in AYA pts. Analysis also suggests ASP-treated pts have lower all-cause Tx costs and fewer days in the hospital compared to other Txs, supporting adoption of PIR regimens in AYA pts.

Sponsorship:: Jazz Pharma