U.S. veterans in the Veterans Affairs (VA) Healthcare System are managed in a national single-payer system with access to FDA-approved therapies. Prescribing patterns and outcomes of patients with CLL manage in the VA system are described.
This is a retrospective analysis of adult patients diagnosed with CLL managed in the VA from January 1999 through December 2020. First line treatment patterns are trended over 20 years. Factors associated with survival were analyzed in both untreated and treated patients.
In the final analysis, 16,331 patients with CLL were included. The median overall survival (OS) for the whole cohort was 8.7 years (95% confidence interval [CI], 8.6-8.9). The median OS from diagnosis was 8.9 years (95% CI, 8.6-9.2 in untreated patients with CLL. In treated patients, the median time to first line treatment was 1.9 years (range, 0-21 years), and the median OS from initiation of treatment was 5.0 years (95% CI, 4.8-5.2). First line treatments varied over time, consistent with FDA approval of targeted therapies. Exposure to targeted therapies as either first line or in subsequent lines of therapy was associated longer survival: median OS of 8.5 years (95% CI, 8.0-9.1) compared to 3.5 years (95% CI, 3.5-3.9) in patients who never received targeted therapy (P < .0001).
Patients treated in the VA have received therapies in line with current evidence-based treatment practices over the past 20 years. Treatment with targeted therapies is associated with longer median OS both in the first line and relapsed/refractory setting.

Published by Elsevier Inc.