EHA 2025 | Healthcare resource utilization in newly diagnosed AML: venetoclax versus non-venetoclax therapies

I’m Pinkal Desai, I’m an associate professor of medicine at Weill Cornell, and this is our abstract that I presented on behalf of my co-authors at EHA 2025. We wanted to understand the healthcare utilization in patients who are newly diagnosed AML when compared with HMA venetoclax versus some of the other high or low intensity regimens. So this was a multi-center chart review study across the globe in the U.S., Israel, and Canada, where we focused on patients where we had venetoclax and HMA treated patients that were considered intensive chemo-ineligible, which basically meant they were either over 75 or had more than one score in the Ferrara criteria. And what we took is we took the HMA-Ven cohort and matched them with controls receiving lower intensity regimens and also controls receiving higher intensive regimens. We had a total of 72 HMA-Ven and what we called CON-L, which is the lower intensity controls, 72 pairs, and for the intensive chemo controls are also known as CON-H. That was 111 pairs. What we wanted to look is per patient per month hospitalizations, how much were outpatient, how many ER visits, how many total home days, and also the cost of utilization. Now, this is important because there is a binary split here, right? So there are trials ongoing, randomizing patients to HMA venetoclax versus intensive chemotherapy. So obviously, healthcare utilization in that situation is an important thing to study. And at the same time, you also wanted to see that, you know, HMA venetoclax is obviously not a totally low intensity, you know, regimen compared to single agent HMA, for example. And we wanted to understand that has toxicity and healthcare utilization actually increased compared to the single agent HMA or lower intensity regimen. So there was, you know, that’s why the intent was to study both these sort of pairs comparing both the low and the high intensity controls. So what we found, so first we, you know, the baseline characteristics were generally, you know, well adjusted. Obviously, as expected, the remission rates for the con low comparison was lower for the lower intensity controls. The CR rate was 18% for them compared to HMA-Ven, which was 48%. Now, that was obviously expected based on the findings from VIALE-A study. So first, we looked at hospitalizations among HMA-Ven compared to lower intensity regimens. And what we found that there was really no difference in terms of the hospitalizations or any home days, which was important because it means that HMA-Ven did not increase healthcare utilization costs compared to some of the lower intensity regimens. What was interesting is that the Ven patients did have, you know, two extra home days compared to controls. And I think this is more to do with the fact that maybe more people were in remission, so they had better, you know, counts and less potential hospitalizations for infection. But overall, this was comparable between the lower intensity regimens versus HMA-Ven. What was important, however, are the high, because that is the bigger comparison that we are currently looking at. Is 7 and 3 replaceable by HMA-Ven? And if the answer to that is yes, based on some of the trials that are ongoing, then understanding how that would impact healthcare utilization. So we looked at this several ways. We wanted to look at the days of hospitalization during induction, and the venetoclax had significantly lower days during induction. But we also wanted to look at before remission and after remission, because obviously after remission mattered a little bit more in terms of intensive chemo comparison. So what we found is both before remission and after remission, the number of hospitalization days were significantly lower among the HMA-Ven group compared to the high intensive chemo. The duration of hospitalization was also lower, which was also significant. And in general, when patients had fewer days of hospitalization per patient per month, about two days versus 5.7 days in the intensive chemo, and the hospitalization was also eight days in the Ven patients versus 13 days per patient per month overall after remission was achieved. So all of this was significant. When translated to actual cost, there was an average of $406 cost savings per patient per month in Ven patients over the higher intensive regimen. So this would obviously would be relevant for the U.S. patients, only that it would actually lead to lesser cost in the lifetime for these patients. And this included, you know, taking into consideration the IP costs and everything else that was relevant. Now, among U.S. patients, reduced hospitalizations corresponded to a mean IP cost saving of $8,671 per patient per month in Ven patients compared to the con high. And in people who did achieve a response, cost savings were actually higher with an average of $22,000 per patient per month before remission and about $7,344 in the 60 days after achieving a complete remission. So in short, what we concluded here is compared to the lower-intensity match controls, patients treated with Ven had similar health care utilization with respect to inpatient admission, outpatient visits, but did have significantly fewer ER visits. So that led to cost savings. Compared to high-intensity controls, patients treated with Ven spent significantly less time enduring inpatient hospitalizations, which also led to cost savings for the U.S. patients. And this would be relevant as we move into perhaps the next version of AML management, where we might consider lower-intensity regimens, even for patients who are currently eligible for intensive chemo based on some of the ongoing trials. Thank you.

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