Estimated Savings after Stopping Tyrosine Kinase Inhibitor Treatment among Patients with Chronic Myeloid Leukemia

Aaron N. Winn; Ehab Atallah; Jorge Cortes; Michael W.N. Deininger; Vamsi Kota; Richard A. Larson; Joseph O. Moore; Michael J. Mauro; Vivian G. Oehler; Javier Pinilla-Ibarz; Jerald P. Radich; Neil P. Shah; James E. Thompson; Kathryn E. Flynn

doi:10.1001/jamanetworkopen.2023.47950

Estimated Savings after Stopping Tyrosine Kinase Inhibitor Treatment among Patients with Chronic Myeloid Leukemia

Aaron N. Winn, Ehab Atallah, Jorge Cortes, Michael W.N. Deininger, Vamsi Kota, Richard A. Larson, Joseph O. Moore, Michael J. Mauro, Vivian G. Oehler, Javier Pinilla-Ibarz, Jerald P. Radich, Neil P. Shah, James E. Thompson, Kathryn E. Flynn

Research output: Contribution to journal › Article › peer-review

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Abstract

Importance: Patients with chronic myeloid leukemia (CML) who have a sustained deep molecular response using tyrosine kinase inhibitors (TKIs) can safely attempt to stop their use. As these medications are very costly, this change in treatment protocols may result in large savings. Objective: To estimate future savings from attempting to stop TKI use among patients with CML who have deep molecular response. Design, Setting, and Participants: A microsimulation model was developed for this decision analytical modeling study to estimate costs for US adults moving from using a TKI, to attempting discontinuation and then reinitiating TKI therapy, if clinically appropriate. Estimates were calculated for US patients who currently have CML and simulated newly diagnosed cohorts of patients over the next 30 years. Exposure: Attempting to stop using a TKI. Main Outcomes and Measures: Estimated savings after attempted discontinuation of TKI use. Results: A simulated population of individuals with CML in 2018 and future populations were created using estimates from the SEER*Explorer website. The median age at diagnosis was 66 years for men and 65 years for women. Between 2022 and 2052, the savings associated with eligible patients attempting discontinuation of TKI therapy was estimated at more than $30 billion among those currently diagnosed and over $15 billion among those who will develop CML in the future, for a total savings of over $54 billion by 2052 for drug treatment and polymerase chain reaction testing. The estimate is conservative as it does not account for complications and other health care-associated costs for patients continuing TKI therapy. Conclusions and Relevance: The findings of this decision analytical modeling study of patients with CML suggest that attempting discontinuation of TKI therapy could save over $54 billion during the next 30 years. Further education for patients and physicians is needed to safely increase the number of patients who can successfully attain treatment-free remission..

Original language	English (US)
Pages (from-to)	E2347950
Journal	JAMA network open
Volume	6
Issue number	12
DOIs	https://doi.org/10.1001/jamanetworkopen.2023.47950
State	Published - Dec 18 2023

ASJC Scopus subject areas

General Medicine

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Winn, A. N., Atallah, E., Cortes, J., Deininger, M. W. N., Kota, V., Larson, R. A., Moore, J. O., Mauro, M. J., Oehler, V. G., Pinilla-Ibarz, J., Radich, J. P., Shah, N. P., Thompson, J. E., & Flynn, K. E. (2023). Estimated Savings after Stopping Tyrosine Kinase Inhibitor Treatment among Patients with Chronic Myeloid Leukemia. JAMA network open, 6(12), E2347950. https://doi.org/10.1001/jamanetworkopen.2023.47950

Winn, AN, Atallah, E, Cortes, J, Deininger, MWN, Kota, V, Larson, RA, Moore, JO, Mauro, MJ, Oehler, VG, Pinilla-Ibarz, J, Radich, JP, Shah, NP, Thompson, JE & Flynn, KE 2023, 'Estimated Savings after Stopping Tyrosine Kinase Inhibitor Treatment among Patients with Chronic Myeloid Leukemia', JAMA network open, vol. 6, no. 12, pp. E2347950. https://doi.org/10.1001/jamanetworkopen.2023.47950

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title = "Estimated Savings after Stopping Tyrosine Kinase Inhibitor Treatment among Patients with Chronic Myeloid Leukemia",

abstract = "Importance: Patients with chronic myeloid leukemia (CML) who have a sustained deep molecular response using tyrosine kinase inhibitors (TKIs) can safely attempt to stop their use. As these medications are very costly, this change in treatment protocols may result in large savings. Objective: To estimate future savings from attempting to stop TKI use among patients with CML who have deep molecular response. Design, Setting, and Participants: A microsimulation model was developed for this decision analytical modeling study to estimate costs for US adults moving from using a TKI, to attempting discontinuation and then reinitiating TKI therapy, if clinically appropriate. Estimates were calculated for US patients who currently have CML and simulated newly diagnosed cohorts of patients over the next 30 years. Exposure: Attempting to stop using a TKI. Main Outcomes and Measures: Estimated savings after attempted discontinuation of TKI use. Results: A simulated population of individuals with CML in 2018 and future populations were created using estimates from the SEER*Explorer website. The median age at diagnosis was 66 years for men and 65 years for women. Between 2022 and 2052, the savings associated with eligible patients attempting discontinuation of TKI therapy was estimated at more than $30 billion among those currently diagnosed and over $15 billion among those who will develop CML in the future, for a total savings of over $54 billion by 2052 for drug treatment and polymerase chain reaction testing. The estimate is conservative as it does not account for complications and other health care-associated costs for patients continuing TKI therapy. Conclusions and Relevance: The findings of this decision analytical modeling study of patients with CML suggest that attempting discontinuation of TKI therapy could save over $54 billion during the next 30 years. Further education for patients and physicians is needed to safely increase the number of patients who can successfully attain treatment-free remission..",

author = "Winn, {Aaron N.} and Ehab Atallah and Jorge Cortes and Deininger, {Michael W.N.} and Vamsi Kota and Larson, {Richard A.} and Moore, {Joseph O.} and Mauro, {Michael J.} and Oehler, {Vivian G.} and Javier Pinilla-Ibarz and Radich, {Jerald P.} and Shah, {Neil P.} and Thompson, {James E.} and Flynn, {Kathryn E.}",

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T1 - Estimated Savings after Stopping Tyrosine Kinase Inhibitor Treatment among Patients with Chronic Myeloid Leukemia

AU - Winn, Aaron N.

AU - Atallah, Ehab

AU - Cortes, Jorge

AU - Deininger, Michael W.N.

AU - Kota, Vamsi

AU - Larson, Richard A.

AU - Moore, Joseph O.

AU - Mauro, Michael J.

AU - Oehler, Vivian G.

AU - Pinilla-Ibarz, Javier

AU - Radich, Jerald P.

AU - Shah, Neil P.

AU - Thompson, James E.

AU - Flynn, Kathryn E.

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Y1 - 2023/12/18

N2 - Importance: Patients with chronic myeloid leukemia (CML) who have a sustained deep molecular response using tyrosine kinase inhibitors (TKIs) can safely attempt to stop their use. As these medications are very costly, this change in treatment protocols may result in large savings. Objective: To estimate future savings from attempting to stop TKI use among patients with CML who have deep molecular response. Design, Setting, and Participants: A microsimulation model was developed for this decision analytical modeling study to estimate costs for US adults moving from using a TKI, to attempting discontinuation and then reinitiating TKI therapy, if clinically appropriate. Estimates were calculated for US patients who currently have CML and simulated newly diagnosed cohorts of patients over the next 30 years. Exposure: Attempting to stop using a TKI. Main Outcomes and Measures: Estimated savings after attempted discontinuation of TKI use. Results: A simulated population of individuals with CML in 2018 and future populations were created using estimates from the SEER*Explorer website. The median age at diagnosis was 66 years for men and 65 years for women. Between 2022 and 2052, the savings associated with eligible patients attempting discontinuation of TKI therapy was estimated at more than $30 billion among those currently diagnosed and over $15 billion among those who will develop CML in the future, for a total savings of over $54 billion by 2052 for drug treatment and polymerase chain reaction testing. The estimate is conservative as it does not account for complications and other health care-associated costs for patients continuing TKI therapy. Conclusions and Relevance: The findings of this decision analytical modeling study of patients with CML suggest that attempting discontinuation of TKI therapy could save over $54 billion during the next 30 years. Further education for patients and physicians is needed to safely increase the number of patients who can successfully attain treatment-free remission..

AB - Importance: Patients with chronic myeloid leukemia (CML) who have a sustained deep molecular response using tyrosine kinase inhibitors (TKIs) can safely attempt to stop their use. As these medications are very costly, this change in treatment protocols may result in large savings. Objective: To estimate future savings from attempting to stop TKI use among patients with CML who have deep molecular response. Design, Setting, and Participants: A microsimulation model was developed for this decision analytical modeling study to estimate costs for US adults moving from using a TKI, to attempting discontinuation and then reinitiating TKI therapy, if clinically appropriate. Estimates were calculated for US patients who currently have CML and simulated newly diagnosed cohorts of patients over the next 30 years. Exposure: Attempting to stop using a TKI. Main Outcomes and Measures: Estimated savings after attempted discontinuation of TKI use. Results: A simulated population of individuals with CML in 2018 and future populations were created using estimates from the SEER*Explorer website. The median age at diagnosis was 66 years for men and 65 years for women. Between 2022 and 2052, the savings associated with eligible patients attempting discontinuation of TKI therapy was estimated at more than $30 billion among those currently diagnosed and over $15 billion among those who will develop CML in the future, for a total savings of over $54 billion by 2052 for drug treatment and polymerase chain reaction testing. The estimate is conservative as it does not account for complications and other health care-associated costs for patients continuing TKI therapy. Conclusions and Relevance: The findings of this decision analytical modeling study of patients with CML suggest that attempting discontinuation of TKI therapy could save over $54 billion during the next 30 years. Further education for patients and physicians is needed to safely increase the number of patients who can successfully attain treatment-free remission..

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Estimated Savings after Stopping Tyrosine Kinase Inhibitor Treatment among Patients with Chronic Myeloid Leukemia

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