It is estimated that 18,960 new cases of chronic lymphocytic leukemia (CLL) were diagnosed in 2016, and 4660 deaths. This type of cancer is more often in older individuals (median age, 71 years) at diagnosis than in patients age <55 years (11%) in the United States. The median survival in patients with CLL ranges from 2 years to >10 years. The first-line standard of care for patients with CLL without deletion (del)17p is a combination chemotherapy with the regimen of fludarabine, cyclophosphamide, and rituximab (FCR) or with the regimen of bendamustine plus rituximab (BR).
An analysis of administrative claims from the Truven Health MarketScan Research database was used to examine differences in healthcare utilization between 2 cohorts of newly diagnosed patients with CLL who received treatment either with BR or FCR. In addition, the investigators analyzed differences across age-groups.
A total of 1795 patients with newly diagnosed CLL were identified who received treatment with first-line BR (N = 946) or with FCR (N = 849). Patients in the BR cohort were significantly older, included more women, and more often had comorbidities compared with the patients who received treatment with the FCR regimen (P <.05 for all differences).
The patients who received the BR regimen had significantly fewer outpatient visits than the patients in the FCR cohort during the first 6 months of therapy, as well as during months 12 to 18 (14.05 vs 17.03, respectively); across all follow-up periods, the patients in the BR cohort were also less likely to have a visit to the emergency department or to be hospitalized (odds ratio [OR], 0.66; P <.05).
Some differences were especially clear between the 2 cohorts. The patients in the FCR cohort who were older (age ≥70 years), had, on average, more outpatient visits (OR for emergency department visit, 1.14), and a greater likelihood of an emergency department visit or a hospitalization stay (OR for hospitalization, 1.50) than the patients in the BR cohort.
Overall, these results suggest that the healthcare utilization among patients with CLL who continue to use the BR regimen is significantly lower than the healthcare utilization of patients who use the FCR regimen long-term. Furthermore, patients aged ≥70 years who received treatment with the FCR regimen had significantly more hospitalizations, outpatient visits, and visits to the emergency department than those who received treatment with the BR regimen.
These results support the use of BR as an effective and safe chemoimmunotherapy option for elderly patients with CLL in the era of novel agents and immunotherapies.