Using a Modified Delphi Panel to Estimate Health Service Utilization for Patients with Advanced and Non-Advanced Systemic Light Chain Amyloidosis

Purpose: Patients with diagnosed with systemic light chain (AL) amyloidosis at advanced Mayo stages have greater morbidity and mortality than those diagnosed at non-advanced stages. Estimating service use by severity is difficult because Mayo stage is not available in many secondary databases. We us...

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Published inClinicoEconomics and outcomes research Vol. 15; pp. 673 - 680
Main Authors Gertz, Morie, Abonour, Rafat, Gibbs, Sarah N, Finkel, Muriel, Landau, Heather, Lentzsch, Suzanne, Lin, Grace, Mahindra, Anuj, Quock, Tiffany, Rosenbaum, Cara, Rosenzweig, Michael, Sidana, Surbhi, Tuchman, Sascha A, Witteles, Ronald, Yermilov, Irina, Broder, Michael S
Format Journal Article
LanguageEnglish
Published Dove Medical Press Limited 30.09.2023
Dove
Dove Medical Press
Subjects
Amyloidosis
Cancer
cardiac failure
Care and treatment
Chemotherapy
consensus
Health aspects
Health care reform
hematology
Hematopoietic stem cells
Implants, Artificial
Japan
mayo stage
Medical care
Medical care, Cost of
Medical research
Medicine, Experimental
Mortality
outcomes research
Pharmaceutical industry
Prosthesis
Short Report
Transplantation
United States
Utilization
United States
Japan
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Summary:Purpose: Patients with diagnosed with systemic light chain (AL) amyloidosis at advanced Mayo stages have greater morbidity and mortality than those diagnosed at non-advanced stages. Estimating service use by severity is difficult because Mayo stage is not available in many secondary databases. We used an expert panel to estimate healthcare utilization among advanced and non-advanced AL amyloidosis patients. Patients and Methods: Using the RAND/UCLA modified Delphi method, expert panelists completed 180 healthcare utilization estimates, consisting of inpatient and outpatient visits, testing, chemotherapy, and procedures by disease severity and organ involve- ment during two treatment phases (the 1 year after starting first line [1L] therapy and 1 year following treatment [post-lL]). Estimates were also provided for post-lL by hematologic treatment response (complete or very good partial response [CR/VGPR], partial, no response or relapse [PR/NR/R]). Areas of disagreement were discussed during a meeting, after which ratings were completed a second time. Results: During lL therapy, 55% of advanced patients had >l hospitalization and 38% had >2 admissions. Rates of hematopoietic stem cell transplant (HSCT) in advanced patients were 5%, while pacemaker or implantable cardioverter defibrillator (ICD) placement were 15%. During post-lL therapy, rates of hospitalization in advanced patients remained high (>l hospitalization: 20-43%, >2 hospitalizations: 10-20%), and up to 10% of advanced patients had a HSCT. Ten percent of these patients underwent pacemaker/ICD placement. Conclusion: Experts estimated advanced patients, who would not be good candidates for HSCT, would have high rates of hospitalization (traditionally the most expensive type of healthcare utilization) and other health service use. The development of new treatment options that can facilitate organ recovery and improve function may lead to decreased utilization. Keywords: consensus, hematology, outcomes research, mayo stage, cardiac failure
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These authors contributed equally to this work
ISSN:1178-6981
1178-6981
DOI:10.2147/CEOR.S412079