Quantifying the financial impact of treatment intolerance in chronic myeloid leukemia on oncology clinical practices: A mixed methods study.

person Jason Shafrin FTI Consulting, Los Angeles, CA info_outline Jason Shafrin, Kehal Jadhav, Cheryl Warren, Sabiha Quddus, Nadine Zawadzki, Daisy Yang, Andrea Damon, Kathryn Spurrier, Katharine Batt, David Wei

Authors person Jason Shafrin FTI Consulting, Los Angeles, CA info_outline Jason Shafrin, Kehal Jadhav, Cheryl Warren, Sabiha Quddus, Nadine Zawadzki, Daisy Yang, Andrea Damon, Kathryn Spurrier, Katharine Batt, David Wei Organizations FTI Consulting, Los Angeles, CA, Novartis Pharmaceuticals Corporation, East Hanover, NJ, FTI Consulting, Boston, MA, FTI Consulting, Washington, DC, Sprouts Consulting, Raleigh, NC Abstract Disclosures Research Funding Novartis Pharmaceuticals Corporation Background: Tyrosine kinase inhibitors (TKIs) have changed the prognosis for patients with chronic myeloid leukemia (CML) to a chronic disease. However, adverse events related to TKI treatment intolerance frequently occur. While the impact of CML treatment intolerance on patient quality of life and cost to health insurers has previously been measured, the time and cost impact to oncology practices is unknown. This mixed methods study aimed to estimate the average time and cost to oncology practices per CML treatment intolerance episode. Methods: The study combined interviews of oncology practice staff with economic modeling. A convenience sample of oncology practice managers was interviewed between October 2023 - January 2024. Interviews aimed to identify and quantify the cost dimensions of addressing treatment intolerance in CML patients. Time impacts reported by respondents were converted into monetary terms using hourly compensation rates of staff needed to complete the identified task. Results: A total of 10 academic oncology practice managers participated in the study. Eight cost dimensions were identified including time spent on prior authorization for medication switch, patient communication, follow-up visits, and care coordination after inpatient stays. Estimated practice time and cost per treatment intolerance episode requiring hospitalization were 34 hours and $3,413 (Table), which were largely attributable to navigating payer prior authorization for medication switch (10 hours, $871), additional follow-up visits (8 hours, $858) and care coordination with inpatient team (9 hours, $782). Activities that could be coded for reimbursement represented only 31.9% of incurred cost. The time and cost per treatment intolerance episode requiring no hospitalization were 17 hours and $1,772. Other burdens not explicitly quantified included negative impact on patient satisfaction, staff morale and care continuity. Conclusions: CML treatment intolerance imposes additional resource and economic burden on oncology practices, and most of these activities are not reimbursed in the current healthcare system. Estimated costs per intolerance episode. Cost Dimension Coded for Reimbursement Average Hours Practice Costs (2023 USD) Navigating payer prior authorization for medication switch No 10 $871 Increased frequency of follow-up visits post-hospitalization* Yes 8 $858 Communicating with inpatient care teams and discharge planning* No 9 $782 Discussions around discontinuation of treatment No 3 $489 Responding to patient calls, emails, and visits regarding symptoms Partially 4 $412 Risk of patients switching practices - - - Patient dissatisfaction - - - Oncology staff dissatisfaction - - - Total (episode requiring no hospitalization) Total (episode requiring hospitalization) 20.6% 31.9% 17 34 $1,772 $3,413 *Hospitalization-related.