Inpatient Charges and Mortality of Richter’s Transformation of Chronic Lymphocytic Leukemia in the United States

Abstract

Specific Aims: The objectives of this study were to determine the financial impact and mortality of CLL and Richter’s transformation in CLL in the inpatient setting in the payer’s perspective, the common diagnoses at discharge for patients with CLL, and to compare demographics, hospital characteristics, and co-morbidities for CLL cases versus Richter’s only cases. Methods: This study was a retrospective cohort of inpatient hospital charges and mortality of CLL patients and CLL patients with Richter’s transformation in the United States in the perspective of the payer. Using weighted statistical methods, results of this investigation yielded nationally-representative findings. The hospital charges were analyzed with a gamma regression with log link, and mortality was analyzed with a generalized linear regression. Main Results: There were total of 391,287 cases and 7% (27,259) were Richter’s cases. The overall hospital charges for CLL and CLL patients with Richter’s transformation from 2005 to 2009 were $38,735 (±58859) per case and $53,118 (±77993) per case, respectively. The mortality was 6.3% (24,520 deaths) overall and 9.1% mortality (2,485 deaths) for Richter’s transformation patients. The significant predictors (p < 0.05) that were associated with an increase the hospital charges for Richter’s patients was sepsis while sepsis and weight loss were associated with an increase in mortality. Conclusions This study adds to the few studies published to show the impact of CLL and Richter’s. However, due to the limitation on pharmacotherapies, it was not possible to determine therapeutic cost drivers for these cases. Future studies are warranted to determine the cost of therapies associated to the different stages of CLL.