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

dc.contributor.authorGertz, Morie
dc.contributor.authorAbonour, Rafat
dc.contributor.authorGibbs, Sarah N.
dc.contributor.authorFinkel, Muriel
dc.contributor.authorLandau, Heather
dc.contributor.authorLentzsch, Suzanne
dc.contributor.authorLin, Grace
dc.contributor.authorMahindra, Anuj
dc.contributor.authorQuock, Tiffany
dc.contributor.authorRosenbaum, Cara
dc.contributor.authorRosenzweig, Michael
dc.contributor.authorSidana, Surbhi
dc.contributor.authorTuchman, Sascha A.
dc.contributor.authorWitteles, Ronald
dc.contributor.authorYermilov, Irina
dc.contributor.authorBroder, Michael S.
dc.contributor.departmentMedicine, School of Medicine
dc.date.accessioned2024-03-12T12:52:41Z
dc.date.available2024-03-12T12:52:41Z
dc.date.issued2023-09-11
dc.description.abstractPurpose: 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 involvement during two treatment phases (the 1 year after starting first line [1L] therapy and 1 year following treatment [post-1L]). Estimates were also provided for post-1L 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 1L therapy, 55% of advanced patients had ≥1 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-1L therapy, rates of hospitalization in advanced patients remained high (≥1 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.
dc.eprint.versionFinal published version
dc.identifier.citationGertz M, Abonour R, Gibbs SN, et al. Using a Modified Delphi Panel to Estimate Health Service Utilization for Patients with Advanced and Non-Advanced Systemic Light Chain Amyloidosis. Clinicoecon Outcomes Res. 2023;15:673-680. Published 2023 Sep 11. doi:10.2147/CEOR.S412079
dc.identifier.urihttps://hdl.handle.net/1805/39202
dc.language.isoen_US
dc.publisherDove Press
dc.relation.isversionof10.2147/CEOR.S412079
dc.relation.journalClinicoEconomics and Outcomes Research
dc.rightsAttribution-NonCommercial 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.sourcePMC
dc.subjectConsensus
dc.subjectHematology
dc.subjectOutcomes research
dc.subjectMayo stage
dc.subjectCardiac failure
dc.titleUsing a Modified Delphi Panel to Estimate Health Service Utilization for Patients with Advanced and Non-Advanced Systemic Light Chain Amyloidosis
dc.typeArticle
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