All studies

Ibrutinib vs chemoimmunotherPatients-with-CLL-Photo-with-spacers.jpgapy (CIT) had lower healthcare utilization and economic burden 




Compared to chemoimmunotherapy, first line use of Ibrutinib in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), a cancer of the blood and bone marrow, can lead to lower costs without compromising quality of care. A study by Carelon Research (formerly HealthCore, Inc.) found $1,687 in savings per month. 

Enterprise Analytics Core domain(s):  Oncology, value of integrated benefits, costs of care, CarelonRx, policy guidance

Summary

Background
NCCN recommend Ibrutinib as a preferred treatment among patients with CLL with/ without del(17p) or TP53 mutation.

Methods
This retrospective claims-based cohort study compared outcomes between first line Ibrutinib users and chemoimmunotherapy users.

Results

  • The study found that total direct costs of care were significantly lower ($1,687 less per month) with Ibrutinib vs CIT in first line treatment of CLL, resulting from higher pharmacy cost of Ibrutinib being fully offset by lower medical cost with Ibrutinib; this was driven mostly by fewer outpatient visits and associated costs (Forrest plot).
  • This study provides complementary evidence that Ibrutinib has an advantage on cost saving over CIT use without compromising quality of care.


Key takeaways
This presents several opportunities to Elevance Health:
  • Considering Ibrutinib as a recommended treatment over CIT among patients with CLL
  • Use this as a case study to support integrated medical and pharmacy benefit


Publication

Poster presented at the Academy of Managed Care Pharmacy (AMCP), April 13–16, 2021.

Carelon Research project team: Mukul Singhal, Joseph Smith



For more information on a specific study or to connect with the Actionable Insights Committee, contact us at [email protected].

This study was conducted by Carelon Research (formerly HealthCore, Inc.), a subsidiary of Elevance Health,  and funded by Pharmacyclics LLC, an AbbVie Company. Dissemination and sharing of the Newsletter is limited to Elevance Health and its subsidiaries and included findings and implications are for Elevance Health and its affiliates’ internal use only.



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Highlighted Studies

A real-world study of immunoglobulin (IG) reveals multiple cost-saving opportunities 

Hub Domain(s): Immunology, oncology, costs of care, IngenioRx, policy guidance
Summary: 

  • Background: Immunoglobulins (IG) are costly blood-derived products accounting for more than $500m in annual spending in the Anthem membership
  • Methods: HealthCore examined IG utilization using claims data to evaluate appropriateness of use, the extent of site-of-care optimization and non-preferred IG use.
  • Results: The findings revealed significant off-label use of IGs (30%), including 22% for indications that were neither approved by FDA nor covered by Anthem, but were accepted by other health plans; and 8% for indications that were neither approved by FDA nor covered by any health plan
    • Additionally, 25% of the IG use was observed in the most expensive site of administration of hospital outpatient (HOPD) and non-preferred IG use accounted for 71% of the total IG use
  • Key Takeaways: Examining the IG uses from various dimensions presents several opportunities to IngenioRx and Anthem:
    • Reducing off-label IG use represented an estimated $27.8m annual savings opportunity
    • Shifting IG utilization from HOPD to a less expensive site of care could drive a further estimated $6.3m in annual savings
    • The study also identified opportunities to increase the share of preferred IG products used by our patients.


Major depressive disorder (MDD) patients highly impacted by COVID-19 face daunting challenges

Hub Domain(s): COVID, member experience
Summary: 

  • Background: Disruption to daily life and lockdown measures that were imposed in an attempt to contain the spread of COVID-19 presented new hurdles for at-risk populations, such as patients with major depressive disorder (MDD)
  • Methods: Conducted a 2020 internet survey to understand reasons for antidepressant continuation, switching and discontinuation in patients with MDD; COVID-19 pandemic questions were developed and added to survey.
    • COVID-19 Pandemic Impact (CPI) score was calculated and, based on their CPI scores, patients were categorized as experiencing low (LPI), medium (MPI) or high pandemic impact (HPI).
  • Results: Compared with LPI and MPI patients, HPI patients reported:
    • Significantly more problems accessing healthcare; few reported not having health insurance benefits due to loss of/reduced health insurance coverage (Figure 1).
    • More challenges obtaining depression prescription medications in terms of:
      • Filling new/current prescription(s)
      • Receiving samples from healthcare providers
      • Paying for prescription(s) due to loss of/reduced health insurance coverage and/or pharmacy benefits
    • Since start of COVID-19 pandemic engaged in significantly more:
      • Alcohol, drug, and tobacco use
      • Unhealthy mindless eating
      • Sedentary behavior
  • Key Takeaways: Our findings are consistent with literature showing that traumatic events, e.g. pandemics, can negatively impact health behaviors.
    • More research is needed to explore the COVID-19 impact in other patient populations.
    • Education opportunities exist for health plans to increase awareness among providers and patients of possible short and long-term COVID-19 effects on health behaviors.

Figure 1: Impact of COVID-19 pandemic on accessing healthcare/mental healthcare

  • Publications: Poster presented at the Virtual American Society of Clinical Psychopharmacology (ASCP) Annual Meeting, June 1-4, 2021

A real-world study of immunoglobulin (IG) reveals multiple cost-saving opportunities

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Teams at Carelon Research