ALBERT

Description: Background: Myeloproliferative neoplasms (MPNs) are chronic myeloid malignancies with markedly heterogeneous disease course, and are associated with underlying inflammatory states that promote development of thrombotic events and acquisition of comorbidities. There is poor understanding of health care resource utilization (HRU) and cost of treatment in patients with MPNs. Objectives:To estimate and compare the HRU and cost of treatment for MPN patients (Essential Thrombocythemia, ET; Polycythemia Vera, PV; and Myelofibrosis, MF) with matched controls, and investigate the impact of patient characteristics and health service factors on the cost of treatment. Study design: Retrospective, population-based, matched-cohort study, using provincial health databases of Ontario's single payer universal health system. Study population: Cases were individuals in the Ontario Cancer Registry, diagnosed with MPN (Total n= 7130; ET, n=3481; PV, n=2618; MF, n=1031), from 2004 to 2016. Controls were individuals in the general population of Ontario, without a diagnosis of MPN. Each case was matched with four controls on age, sex, geographical location, and neighborhood income quintile. Baseline parameters including thrombosis and other comorbidities were collected during two-years prior to the date of MPN diagnosis. The baseline comorbid disease burden was measured using the Aggregated Diagnostic Group (ADG) score with a larger number of ADGs representing a greater comorbid disease burden (https://www.johnshopkinssolutions.com/wp-content/uploads/2014/04/ACG-White-Paper-Applications-Dec-2012.pdf). Main outcome measures:For each case and its controls, direct medical costs were obtained by costing all health care-related resources and expressed as mean per person year costs ((2018 Canadian Dollars, $1 CDN = $0.76 USD) to adjust for variable length of follow-up. Linear regression analysis was performed to assess the impact of baseline factors on the cost of treatment for MPN and represented as rate ratios (95% CI). Results:The mean duration of follow-up in years (cases vs controls) was 3.9 vs 4.3 for ET; 3.9 vs 4.2 for PV and 3.2 vs 4.9 for MF. The total follow-up duration was 27449 person years for all MPN cases, and 124963 person years for all controls. Comorbidities (congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, stroke, chronic renal failure, chronic liver disease, and pre-diagnosis arterial and venous thromboses were significantly higher in cases as compared to controls (p6 months after the diagnosis incurred significantly lesser cost of treatment due to less comorbidity burden as noted by the lower ADG score for patients with 〉6 months vs