Thromboembolic Events Are Associated With Higher Costs in Patients With Polycythemia Vera

Even when taking cytoreductive treatments, patients with polycythemia vera (PV) are at elevated risk for thromboembolic events (TEs) and cardiovascular disease. Cardiovascular mortality has previously been demonstrated to account for 45% of all deaths of patients with PV, and nonfatal TEs affect another 10.3% of patients. In addition to the clinical burden of the disease, patients with PV also have a higher financial burden as a result of their higher healthcare resource utilization and associated costs.

A recent paper sought to address the knowledge gap in the literature with respect to the effects of cardiovascular events and TEs on healthcare cost associated with patients receiving hydroxyurea and found that patients who receive this therapy remain at risk for TEs, and those who have a TE experience increased healthcare resource utilization and higher costs.

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Using Truven’s MarketScan database, the researchers identified the records of 1322 patients with PV who were newly treated with hydroxyurea. These patients were then included in a retrospective cross-sectional analysis. Of this group, 14% had a history of TEs within the year prior to hydroxyurea initiation. Anagrelide was the most common PV medication taken before initiating hydroxyurea, and the median starting dose of hydroxyurea was 500 mg per day.

In total, 16.3% of patients experienced TEs in the year following initiation of hydroxyurea. Among these patients, 44.9% had a documented history of TEs. During the 12 months following treatment initiation, patients who had TEs were more likely to have an inpatient admission than were those without TEs (50.9% versus 18.4%, P <.001) and more likely to have an emergency department visit than were those without TEs (48.2% versus 26.3%, P <.001).

Additionally, those with TEs had a higher mean number of inpatient admission and outpatient office visits, and they received a greater mean number of prescriptions for any medication than those who did not have TEs.

Patients who had a TE had significantly higher total annual costs ($45,040; standard deviation [SD], $106,119) than those who did not ($16,438; SD, $27,919). For 9.3% of the patients who had TEs, total annual costs exceeded $100,000. The difference in costs was driven, wrote the authors, by higher inpatient and outpatient costs.

“The current study is novel because, to our knowledge, it is the first to demonstrate that the occurrence of TEs in patients with PV is associated with higher health care resource utilization and costs, despite treatment with [hydroxyurea],” wrote the authors. “These findings support the regular assessment of patients with PV for signs of inadequate disease control and the identification of those at increased risk of developing TEs to ensure that appropriate therapy is initiated accordingly.”

Reference

Parasuraman SV, Shi N, Paranagama D, Bonafede M. Health care costs and thromboembolic events in hydroxyurea-treated patients with polycythemia vera. J Manag Care Spec Pharm. 2018;24(1): 47-55. doi: 10.18553/jmcp.2018.24.1.47.