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Mehta P, Campbell V, Maddox J, Floisand Y, Kalakonda AJM, O'Nions J, Coats T, Nagumantry S, Hodgson K, Whitmill R, Amott I, Flynn G, Taussig D, Zhao R, Cunningham N, Roset M, Cuadras D, Medalla G, Kuter H, Park S, Legg A, Khan AB. CREST-UK: Real-world effectiveness, safety and outpatient delivery of CPX-351 for first-line treatment of newly diagnosed therapy-related AML and AML with myelodysplasia-related changes in the UK. Br J Haematol 2024. [PMID: 38977430 DOI: 10.1111/bjh.19622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/20/2024] [Indexed: 07/10/2024]
Abstract
Favourable outcomes with CPX-351 versus conventional 7 + 3 were demonstrated in the pivotal phase III trial in adults aged 60-75 years with newly diagnosed, highrisk/secondary acute myeloid leukaemia (AML). As a complement to the clinical trial and to address important data gaps, the CPX-351 Real-World Effectiveness and SafeTy (CREST-UK; NCT05169307) study evaluated the use of CPX-351 in routine clinical practice in the UK, in 147 patients with newly diagnosed therapy-related AML or AML with myelodysplasia-related changes. Best response of complete remission or complete remission with incomplete platelet or neutrophil recovery was achieved by 53% of evaluable patients. Kaplan-Meier median overall survival (OS) was 12.8 months (95% confidence interval 9.2-15.3). Fifty (34%) patients proceeded to haematopoietic cell transplantation (HCT); median OS landmarked from the HCT date was not reached. There were no new safety concerns with CPX-351 identified in CREST-UK. Patients treated with CPX-351 in the outpatient setting spent an average of 24.4, 16.7, 28.2, and 27.7 fewer days on the ward compared with inpatients during first induction, second induction, first consolidation, and second consolidation, respectively. The results from CREST-UK provide valuable insights into the effectiveness, safety, and outpatient delivery of CPX-351 in routine clinical practice in the UK.
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Affiliation(s)
- Priyanka Mehta
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Jamie Maddox
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Yngvar Floisand
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Anita J M Kalakonda
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
- NIHR CRN North West Coast, Liverpool, UK
| | - Jenny O'Nions
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Thomas Coats
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | | | | | - Ian Amott
- University Hospitals Derby & Burton, NHS Foundation Trust, Derby, UK
| | - Gillian Flynn
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - David Taussig
- Haemato-Oncology Department, Royal Marsden Hospital, UK
- Institute of Cancer Research, London, UK
| | - Rui Zhao
- Torbay and South Devon NHS Foundation Trust, UK
| | | | | | | | | | | | | | | | - Anjum B Khan
- Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
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Solana-Altabella A, Megías-Vericat JE, Ballesta-López O, Boluda B, Cano I, Acuña-Cruz E, Rodríguez-Veiga R, Torres-Miñana L, Sargas C, Sanz MÁ, Borrell-García C, López-Briz E, Poveda-Andrés JL, De la Rubia J, Montesinos P, Martínez-Cuadrón D. Healthcare Resource Utilization among Patients between 60-75 Years with Secondary Acute Myeloid Leukemia Receiving Intensive Chemotherapy Induction: A Spanish Retrospective Observational Study. Cancers (Basel) 2022; 14:cancers14081921. [PMID: 35454828 PMCID: PMC9032151 DOI: 10.3390/cancers14081921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Studies addressing the economic costs and burden of secondary acute myeloid leukemia (sAML) are scarce in the literature. We analyzed this topic in a real-life population of sAML patients between 60–75 years receiving intensive chemotherapy induction. In elderly patients with sAML and intensive regimens, it entails an increase in costs and a longer hospital stay. In these specific patients, almost a third of the time is spent hospitalized after the diagnosis of sAML. There are no studies with this type of population and diagnosis, which gives added value to the results obtained. Pharmacoeconomic studies in patients with AML are being carried out due to the need to evaluate the cost-effectiveness of new oral drugs, therapeutic schemes with higher costs than previous treatments. Abstract Background: Information regarding the impact on healthcare systems of secondary acute myeloid leukemia (sAML) is scarce. Methods: A retrospective review of medical charts identified patients aged 60–75 years with sAML between 2010 and 2019. Patient information was collected from diagnosis to death or last follow-up. Outpatient resource use, reimbursement, frequency and duration of hospitalization, and transfusion burden were assessed. Forty-six patients with a median age of 64 years were included. Anthracycline plus cytarabine regimens were the most common induction treatment (39 patients, 85%). The ratio of the total days hospitalized between the total follow-up was 29%, with a sum of 204 hospitalizations (average four/patient; average duration 21 days). The total average reimbursement was EUR 90,008 per patient, with the majority (EUR 77,827) related to hospital admissions (EUR 17,403/hospitalization). Most hospitalizations (163, mean 22 days) occurred in the period before the first allogeneic hematopoietic stem cell transplant (alloHSCT), costing EUR 59,698 per patient and EUR 15,857 per hospitalization. The period after alloHSCT (in only 10 patients) had 41 hospitalizations (mean 21 days), and a mean reimbursement cost of EUR 99,542 per patient and EUR 24,278 per hospitalization. In conclusion, there is a high consumption of economic and healthcare resources in elderly patients with sAML receiving active treatments in Spain.
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Affiliation(s)
- Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
| | - Juan Eduardo Megías-Vericat
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Octavio Ballesta-López
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
| | - Blanca Boluda
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Isabel Cano
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Evelyn Acuña-Cruz
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Laura Torres-Miñana
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Claudia Sargas
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Miguel Á. Sanz
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Carmela Borrell-García
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Eduardo López-Briz
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - José Luis Poveda-Andrés
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Javier De la Rubia
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- School of Medicine and Dentistry, Catholic University of Valencia, 46010 Valencia, Spain
| | - Pau Montesinos
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-96-1244000 (ext. 4119661)
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Bewersdorf JP, Patel KK, Goshua G, Shallis RM, Podoltsev NA, Huntington SF, Zeidan AM. Cost-effectiveness of liposomal cytarabine/daunorubicin in patients with newly diagnosed acute myeloid leukemia. Blood 2022; 139:1766-1770. [PMID: 35298594 PMCID: PMC8931513 DOI: 10.1182/blood.2021014401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jan Philipp Bewersdorf
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and
| | - Kishan K Patel
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - George Goshua
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Nikolai A Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Scott F Huntington
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Amer M Zeidan
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
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Price K, Cao Z, Lipkin C, Profant D, Robinson S. Comparison of Hospital Length of Stay and Supportive Care Utilization Between Patients Treated with CPX-351 and 7+3 for Therapy-Related Acute Myeloid Leukemia or Acute Myeloid Leukemia with Myelodysplasia-Related Changes. Clinicoecon Outcomes Res 2022; 14:21-34. [PMID: 35035224 PMCID: PMC8754465 DOI: 10.2147/ceor.s342303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022]
Abstract
Purpose CPX-351 is dual-drug liposomal encapsulation of daunorubicin and cytarabine at a fixed synergistic 1:5 molar ratio. This study determined current real-world use of CPX-351 versus conventional 7+3 (cytarabine+daunorubicin) therapy and evaluated hospital length of stay (LOS) and supportive care utilization in t-AML and AML-MRC. Patients and Methods This retrospective, observational study utilized the Premier Healthcare Database and included patients who were aged ≥18 years with t-AML or AML-MRC and treated with CPX-351 or 7+3 between August 1, 2017 and February 28, 2019. All patients treated with 7+3 were required to be eligible for CPX-351 based on its FDA-approved indication. Outcome variables were annualized and adjusted for patient, hospital, and clinical confounding factors. The primary outcome was inpatient LOS. Secondary outcomes included use of blood products and use of anti-infectives. Results The study included 195 qualifying patients treated with CPX-351 and 160 patients treated with 7+3 who were eligible for CPX-351. Approximately one-third of the patients treated with CPX-351 were administered therapy in a hospital-based outpatient setting, and all patients treated with 7+3 received it in the inpatient setting. The regression-adjusted annualized inpatient LOS was shorter with CPX-351 than 7+3 (mean of 183.7 vs 197.1 days, p<0.001). The difference in mean-adjusted LOS was most pronounced for t-AML, with a mean-adjusted LOS of 168.9 versus 192.5 days for CPX-351 versus 7+3, respectively (nominal p<0.001). Supportive care utilization, including the number of administrations of red blood cells, the number of administrations of platelets, and the number of days on anti-infectives, was similar between treatment groups. Conclusion CPX-351 was associated with a shorter inpatient LOS than 7+3. Supportive care use, including blood products and anti-infectives, was similar for CPX-351 and 7+3. These findings suggest CPX-351 conveys resource advantages over 7+3 in patients with newly diagnosed t-AML and AML-MRC.
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Affiliation(s)
| | - Zhun Cao
- Premier Inc., Charlotte, NC, USA
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Cortes JE, Lin TL, Uy GL, Ryan RJ, Faderl S, Lancet JE. Quality-adjusted Time Without Symptoms of disease or Toxicity (Q-TWiST) analysis of CPX-351 versus 7 + 3 in older adults with newly diagnosed high-risk/secondary AML. J Hematol Oncol 2021; 14:110. [PMID: 34256819 PMCID: PMC8276472 DOI: 10.1186/s13045-021-01119-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND CPX-351 (United States: Vyxeos®; Europe: Vyxeos® Liposomal), a dual-drug liposomal encapsulation of daunorubicin and cytarabine in a synergistic 1:5 molar ratio, is approved by the US FDA and the EMA for the treatment of adults with newly diagnosed therapy-related acute myeloid leukemia or acute myeloid leukemia with myelodysplasia-related changes. In a pivotal phase 3 study that evaluated 309 patients aged 60 to 75 years with newly diagnosed high-risk/secondary acute myeloid leukemia, CPX-351 significantly improved median overall survival versus conventional 7 + 3 chemotherapy (cytarabine continuous infusion for 7 days plus daunorubicin for 3 days), with a comparable safety profile. A Quality-adjusted Time Without Symptoms of disease or Toxicity (Q-TWiST) analysis of the phase 3 study was performed to compare survival quality between patients receiving CPX-351 versus conventional 7 + 3 after 5 years of follow-up. METHODS Patients were randomized 1:1 between December 20, 2012 and November 11, 2014 to receive induction with CPX-351 or 7 + 3. Survival time for each patient was partitioned into 3 health states: TOX (time with any grade 3 or 4 toxicity or prior to remission), TWiST (time in remission without relapse or grade 3 or 4 toxicity), and REL (time after relapse). Within each treatment arm, Q-TWiST was calculated by adding the mean time spent in each health state weighted by its respective quality-of-life, represented by health utility. The relative Q-TWiST gain, calculated as the difference in Q-TWiST between treatment arms divided by the mean survival of the 7 + 3 control arm, was determined in order to evaluate results in the context of other Q-TWiST analyses. RESULTS The relative Q-TWiST gain with CPX-351 versus 7 + 3 was 53.6% in the base case scenario and 39.8% among responding patients. Across various sensitivity analyses, the relative Q-TWiST gains for CPX-351 ranged from 48.0 to 57.6%, remaining well above the standard clinically important difference threshold of 15% for oncology. CONCLUSIONS This post hoc analysis demonstrates that CPX-351 improved quality-adjusted survival, further supporting the clinical benefit in patients with newly diagnosed high-risk/secondary acute myeloid leukemia. Trial registration This trial was registered on September 28, 2012 at www.clinicaltrials.gov as NCT01696084 ( https://clinicaltrials.gov/ct2/show/NCT01696084 ) and is complete.
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Affiliation(s)
- Jorge E Cortes
- Georgia Cancer Center, Augusta University, 1410 Laney Walker Rd., CN2116, Augusta, GA, 30912, USA.
| | - Tara L Lin
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Geoffrey L Uy
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Jeffrey E Lancet
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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