CML Treatment Intolerance Increases Time and Economic Burden Among Practice Providers
Key Takeaways:
- Researchers interviewed several oncology practice managers and found that chronic myeloid leukemia (CML) treatment intolerance significantly increased the time and cost spent on patient care, most of which was non-reimbursable.
- Navigating payer prior authorization (PA) was a main driver of administrative burden, along with higher health care utilization and increased care support.
- Strategies developed to address key areas of impact may help reduce the administrative burden among practice providers and improve reimbursement practices.
While tyrosine kinase inhibitors (TKIs) have transformed CML from a lethal disease to a manageable chronic condition, treatment intolerance remains a concern that carries significant economic and administrative burden among patients and providers.
To quantify the provider burden associated with TKI intolerance, researchers interviewed 10 US oncology practice managers to determine the average time and cost for each intolerance episode. An intolerance episode was defined as an adverse event resulting from CML treatment and included both minor symptoms and serious reactions that required hospitalization.
TKI Intolerance Associated With Non-Reimbursable Time and Costs
Based on the interviews, researchers estimated that an intolerance episode incurred an average additional 16.1 hours and $1740 among non-hospitalized patients. For hospitalized patients, practice time and costs nearly doubled to 33.5 hours and $3380 per intolerance episode.
Despite the substantial burden, practice managers reported that only about 31% of additional activities were reimbursable.
Drivers of Treatment Intolerance Burden Among Providers
Payer PA interactions for medication switching had the greatest impact on time and costs among practice providers. Although these additional activities, including coordination of peer-to-peer reviews and decision appeals, are crucial for ensuring patient access, they are non-reimbursable and place a significant time burden on staff.
Increased utilization and management also incur additional time and costs. Intolerance episodes requiring hospitalizations were nearly twice as time-consuming as non-hospitalized episodes due to inpatient care coordination, including chart reviews, treatment research, and documentation.
Furthermore, monitoring and communicating with patients during and after each episode increased burden among providers. These activities are the only ones eligible for reimbursement.
Improving Administrative Burden
The authors suggested multiple strategies that may reduce the burden of CML treatment intolerance among providers.
Dedicating clerical prior authorization work to non-clinical staff could significantly reduce provider workload and shift the focus back to patient care.
Improving system operations through the implementation of enhanced electronic health records and shared data systems could streamline provider communications.
Reforming reimbursement policies could allow providers to receive appropriate compensation for the additional work incurred during an intolerance episode.
Implications for Managed Care
These findings highlight how administrative restrictions can increase provider workload without providing adequate compensation.
Each CML treatment intolerance episode resulted in a significant increase in time and costs among practice providers, especially for episodes that required hospitalization.
This study identified key areas of impact. Addressing these with targeted strategies may reduce the burden among providers and improve support for patient care.
Reference
Shafrin J, Jadhav K, Warren C, et al. Chronic myeloid leukemia treatment intolerance imposes additional resource and economic burden on oncology practices in the United States. J Med Econ. 2025;28(1):2082-2090. doi:10.1080/13696998.2025.2593796
