Posttransplant AML Maintenance Therapy Increases Health Care Resource Use
Key Clinical Summary
- Patients with acute myeloid leukemia (AML) receiving maintenance therapy after allogeneic hematopoietic cell transplantation (allo-HCT) had significantly more office visits, outpatient visits, and inpatient admissions than patients receiving allo-HCT alone.
- Monthly pharmacy costs were significantly higher with maintenance therapy ($6433.81 vs $3132.51; P = .002).
- Despite greater resource use, total monthly health care costs were not significantly different between groups.
Maintenance therapy following allo-HCT for AML was associated with increased health care resource utilization (HCRU) and pharmacy spending, according to a retrospective US study published in the Journal of Managed Care & Specialty Pharmacy. Researchers from the University of Washington compared 12-month utilization and costs among patients who received posttransplant maintenance therapy with those receiving allo-HCT alone.
Maintenance Therapy Associated With Greater Resource Utilization
Researchers analyzed Merative MarketScan claims from October 2015 through March 2024. The study included commercially insured patients, Medicaid enrollees from participating US states, and Medicare-eligible beneficiaries with employer-sponsored supplemental coverage. Of 373 eligible patients with AML, 43 received maintenance therapy and 330 received allo-HCT alone.
Among patients receiving maintenance therapy, venetoclax was most common (55.8%), followed by sorafenib (20.9%) and gilteritinib (14.0%). Median time from allo-HCT to the first maintenance therapy fill was 244 days, and median observed treatment duration was 59 days.
After inverse probability treatment weighting, maintenance therapy was associated with significantly higher rates of office visits (incidence rate ratio [IRR], 3.23; P = .004), outpatient visits (IRR, 4.26; P < .001), and inpatient admissions (IRR, 1.34; P = .034). Specialist clinic and emergency department visit rates were numerically higher but did not reach statistical significance.
Weighted mean monthly pharmacy costs were $6433.81 with maintenance therapy compared with $3132.51 for allo-HCT alone (P = .002). Total monthly health care costs were numerically higher with maintenance therapy ($17 137.09 vs $11 613.85), but the difference was not statistically significant (P = .054).
Higher Pharmacy Spending Shapes Posttransplant Care Costs
The findings illustrate how posttransplant AML maintenance therapy may shift resource use following allo-HCT. Although inpatient costs dominated during transplantation, pharmacy costs became the primary cost driver beginning in the first month after allo-HCT and accounted for much of monthly spending during follow-up.
Importantly, greater utilization did not translate into a statistically significant increase in total health care costs. Patients receiving maintenance therapy also had a significantly shorter weighted mean hospital length of stay than the allo-HCT-only group (21.40 vs 26.53 days; P = .004), while blood transfusion requirements remained minimal in both cohorts.
For managed care stakeholders, the authors said the findings highlight the need to balance the clinical benefits of maintenance therapy against its resource demands. The study's implications for managed care pharmacy specifically emphasize care coordination as a strategy to optimize outcomes and resource use after allo-HCT.
Balancing Clinical Benefits With Resource Demands
The investigators noted that increased resource needs may reflect the clinical requirements of maintenance therapy, which is intended to reduce relapse risk but requires additional monitoring and management of treatment-related toxicities. They wrote that the findings underscore the need for further research “to optimize the balance between clinical benefit and economic impact.”
Longer-term studies are needed to better characterize the economic impact of AML maintenance therapy after allo-HCT, particularly because the 12-month follow-up captured only a portion of potential maintenance exposure.
Reference
Kneitel R, Lee K, Kreif N. Health care resource utilization and costs in patients with acute myeloid leukemia treated with posttransplant maintenance therapy. J Manag Care Spec Pharm. 2026;32(8):932-944. doi:10.18553/jmcp.2026.32.8.932
