Healthcare resource utilization and costs in amyloid light-chain amyloidosis: a real-world study using US claims data
Abstract
Aim: To estimate healthcare utilization and costs in amyloid light-chain (AL) amyloidosis. Patients & methods: AL amyloidosis patients were identified in 2007–2015 claims databases if they had ≥1 inpatient/≥2 outpatient claims consistent with AL amyloidosis and received ≥1 AL-specific treatment. Descriptive statistics were reported. Results: 50.1% (n = 3670) were admitted ≥1 time during the year, 11.3% (n = 827) ≥3 times. From 2007 to 2015, bortezomib use increased from 4.6 to 25.3%; melphalan use decreased from 18.9 to 2.0%; costs increased from 92,866 to $114,030. Among incident patients with at least 2 years of follow-up, healthcare utilization and costs decreased from first to second year post-diagnosis. Conclusion: AL chemotherapy-based prescribing practices changed. Total annual healthcare costs increased over time among AL amyloidosis patients.
Formats available
You can view the full content in the following formats:
References
Papers of special note have been highlighted as: • of interest
1.
Pathogenesis of immunoglobulin light chain (AL) amyloidosis and light and heavy chain deposition diseases – UpToDate. www.uptodate.com/contents/pathogenesis-of-immunoglobulin-light-chain-al-amyloidosis-and-light-and-heavy-chain-deposition-diseases?source=search_result&search=pathogenesis-of-immunoglobulin-light-chain-al-amyloidosis-and-light-and-heavy-chain-deposition-diseases.&selectedTitle=1∼150.
2.
Rosenzweig M, Landau H. Light chain (AL) amyloidosis: update on diagnosis and management. J. Hematol. Oncol. 4, 47 (2011).
3.
Sanchorawala V. Light-chain (AL) amyloidosis: diagnosis and treatment. Clin. J. Am. Soc. Nephrol. 1(6), 1331–1341 (2006).
4.
Weiss BM, Lund SH, Bjorkholm M et al. Improved survival in AL amyloidosis: a population-based study on 1430 patients diagnosed in Sweden 1995–2013. Blood 128(22), 4448–4448 (2016).
5.
Janssen S, Van Rijswijk MH, Meijer S, Ruinen L, Van der Hem GK. Systemic amyloidosis: a clinical survey of 144 cases. Neth. J. Med. 29(11), 376–385 (1986).
6.
Kyle RA, Linos A, Beard CM et al. Incidence and natural history of primary systemic amyloidosis in Olmsted County, Minnesota, 1950 through 1989. Blood 79(7), 1817–1822 (1992).
• Original epidemiology study of amyloidosis in the USA.
7.
Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin. Hematol. 32(1), 45–59 (1995).
8.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Systemic Light Chain Amyloidosis. www.nccn.org/professionals/physician_gls/default.aspx.
• NCCN guidelines provide an understanding of practice guidelines to make sense of the increase in bortezomib use we observed.
9.
Zhao Q, Li F, Song P et al. Clinical characteristics and treatment outcome of Chinese patients with systemic amyloid light-chain amyloidosis: a retrospective single-center analysis. Clin. Lymphoma Myeloma Leuk. 16(2), 104–110 (2016).
10.
Paul A, Dispenzieri A, Gertz M et al. Therapeutic strategies for initial treatment of AL amyloidosis: implications of therapy and response on outcome. Blood 122, 3343 (2013).
11.
Palladini G, Perfetti V, Obici L et al. Association of melphalan and high-dose dexamethasone is effective and well tolerated in patients with AL (primary) amyloidosis who are ineligible for stem cell transplantation. Blood 103(8), 2936–2938 (2004).
12.
Falk RH. Diagnosis and management of the cardiac amyloidoses. Circulation 112(13), 2047–2060 (2005).
13.
Merlini G, Wechalekar AD, Palladini G. Systemic light-chain amyloidosis: an update for treating physicians. Blood 121(26), 5124–5130 (2013).
14.
Lin HM, Gao X, Cooke CE et al. Disease burden of systemic light-chain amyloidosis: a systematic literature review. Curr. Med. Res. Opin. 33(6), 1017–1031 (2017).
• Understanding disease burden is necessary to understand healthcare resource utilization.
15.
Teitelbaum A, Ba-Mancini A, Huang H, Henk HJ. Health care costs and resource utilization, including patient burden, associated with novel-agent-based treatment versus other therapies for multiple myeloma: findings using real-world claims data. Oncologist 18(1), 37–45 (2013).
16.
Khera N, Zeliadt SB, Lee SJ. Economics of hematopoietic cell transplantation. Blood 120(8), 1545–1551 (2012).
• Because approximately 20% of patients receive hematopoietic cell transplant, understanding the cost of this treatment is important.
17.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic Dis. 40(5), 373–383 (1987).
18.
Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA 315(21), 2284 (2016).
19.
Kastritis E, Anagnostopoulos A, Roussou M et al. Treatment of light-chain (AL) amyloidosis with the combination of bortezomib and dexamethasone. Haematologica 92(10), 1351–1358 (2007).
20.
Sitia R, Palladini G, Merlini G. Bortezomib in the treatment of AL amyloidosis: targeted therapy? Haematologica 92(10), 1302–1307 (2007).
• Found an increase in bortezomib use in our study period; hence, understanding this therapy and its uses is important.
21.
Laudicella M, Walsh B, Burns E, Smith PC. Cost of care for cancer patients in England: evidence from population-based patient-level data. Br. J. Cancer 114(11), 1286–1292 (2016).
22.
Dieguez G, Ferro C, Pyenson BS. A multi-year look at the cost burden of cancer care. Milliman Inc., New York, NY, USA (2017). www.milliman.com/insight/2017/A-multi-year-look-at-the-cost-burden-of-cancer-care/.
23.
Dunlay SM, Shah ND, Shi Q et al. Lifetime costs of medical care after heart failure diagnosis. Circ. Cardiovasc. Qual. Outcomes. 4(1), 68–75 (2011).
• A total of 50–70% of amyloidosis patients have cardiac involvement, which manifests as heart failure, so costs of care for cardiac involvement in amyloidosis can be estimated with data on heart failure patients.
Information & Authors
Information
Published In
Copyright
© 2018 Tiffany Quock.
History
Received: 13 December 2017
Accepted: 17 January 2018
Published online: 2 February 2018
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Healthcare resource utilization and costs in amyloid light-chain amyloidosis: a real-world study using US claims data. (2018) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2017-0100
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Jeffrey Thompson, Ankita Gupta, Julia Catini, Pedro Laires, Economic Burden of Overall and Advanced Light Chain Amyloidosis: Results from a Claims Linked Electronic Health Record Database Analysis, ClinicoEconomics and Outcomes Research, 10.2147/CEOR.S584774, Volume 18, (1-9), (2026).
- Ashley F. Stein-Merlob, Rachel Swier, Darko Vucicevic, Evolving Strategies in Cardiac Amyloidosis, Heart Failure Clinics, 10.1016/j.hfc.2025.11.005, 22, 2, (243-260), (2026).
- Carissa White, Stephen Savioli, Eric A. Walker, Chika Iloanusi Logie, Mark D. Murphey, Amyloidosis, Musculoskeletal Imaging, 10.1007/978-3-030-57376-8_73-1, (1-14), (2025).
- Genevieve Lyons, Jeffrey Thompson, Isabelle Lousada, Julia Catini, Richa Manwani, Mathew S Maurer, Diagnostic pathways, cardiac manifestations and outcomes in light chain amyloidosis: analysis of a US claims database, Open Heart, 10.1136/openhrt-2024-003124, 12, 1, (e003124), (2025).
- Ashley F. Stein-Merlob, Rachel Swier, Darko Vucicevic, Evolving Strategies in Cardiac Amyloidosis, Cardiology Clinics, 10.1016/j.ccl.2024.09.006, 43, 1, (93-110), (2025).
- Blake Angell, Siyuan Wang, Thomas Gadsden, Monica Moorthy, Charu Malik, Jonathan Barratt, Olivier Devuyst, Ifeoma I. Ulasi, Daniel P. Gale, Agnivo Sengupta, Anna Palagyi, Vivekanand Jha, Stephen Jan, Scoping Review of Economic Analyses of Rare Kidney Diseases, Kidney International Reports, 10.1016/j.ekir.2024.09.004, 9, 12, (3553-3569), (2024).
- Patrick Hagen, Anita D'Souza, Autologous stem cell transplantation in AL amyloidosis: Muddy waters, Blood Reviews, 10.1016/j.blre.2024.101228, 68, (101228), (2024).
- Shih-Pei Shen, Hsin-An Hou, Kuan-Chih Huang, Choo Hua Goh, Hong Qiu, Lee Anne Rothwell, Kwang-Wei Wu, Hitesh Chandwani, Yanfang Liu, Chao-Hsiun Tang, Healthcare resource utilisation and costs associated with AL amyloidosis: a retrospective matched cohort study, Scientific Reports, 10.1038/s41598-024-65654-5, 14, 1, (2024).
- Arnaud Jaccard, Frank Bridoux, Wilfried Roeloffzen, Monique C. Minnema, Rui Bergantim, Roman Hájek, Cristina João, M. Teresa Cibeira, Giovanni Palladini, Stefan Schönland, Giampaolo Merlini, Paolo Milani, Meletios A. Dimopoulos, Sriram Ravichandran, Ute Hegenbart, Hermine Agis, Blanca Gros, Aisha Asra, Valeria Magarotto, Giorgos Cheliotis, Giorgos Psarros, Pieter Sonneveld, Ashutosh Wechalekar, Efstathios Kastritis, Healthcare Resource Utilization and Cost-of-Illness in Systemic Light Chain (AL) Amyloidosis in Europe: Results From the Real-World, Retrospective EMN23 Study, Clinical Lymphoma Myeloma and Leukemia, 10.1016/j.clml.2024.01.013, 24, 5, (e205-e216), (2024).
- Neha Chopra, Sudheer Kumar Arava, Chetan Patel, Sanjeev Kumar, Sandeep Seth, Cardiac Amyloidosis: Approach to Diagnosis, Journal of the Practice of Cardiovascular Sciences, 10.4103/jpcs.jpcs_78_23, 10, 1, (1-8), (2024).
