Real-World Characteristics, Treatment Patterns, Health Care Resource Use, and Costs of Patients with Diffuse Large B-Cell Lymphoma in the U.S

Abstract

Background Diffuse large B‐cell lymphoma (DLBCL) represents the most common subtype of non‐Hodgkin lymphoma in the U.S., but current real‐world data are limited. This study was conducted to describe real‐world characteristics, treatment patterns, health care resource utilization (HRU), and health care costs of patients with treated DLBCL in the U.S. Materials and Methods A retrospective study was conducted using the Optum Clinformatics Data Mart database (January 2013 to March 2018). Patients with an International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis for DLBCL after October 2015 and no prior International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis for unspecified DLBCL or primary mediastinal large B‐cell lymphoma were classified as incident; those with such codes were classified as prevalent. An adapted algorithm identified lines of therapy (e.g., first line [1L]). All‐cause HRU and costs were calculated per‐patient‐per‐year (PPPY) among patients with a ≥1L. Results Among 1,877 incident and 651 prevalent patients with ≥1L, median age was 72 years and 46% were female. Among incident patients, 22.6% had at least two lines (2L), whereas 38.4% of prevalent patients had ≥2L. The most frequent 1L therapy was rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP). Incident patients had 1.3 inpatient and 42.0 outpatient (OP) visits PPPY, whereas prevalent patients had 0.8 and 31.3 visits PPPY, respectively. Total costs were $137,156 and $81,669 PPPY for incident and prevalent patients, respectively. OP costs were the main driver of total costs at $88,202 PPPY, which were higher within the first year. Conclusion This study showed that a large portion of patients require additional therapy after 1L treatment to manage DLBCL and highlighted the substantial economic burden of patients with DLBCL, particularly within the first year following diagnosis. Implications for Practice Patients diagnosed with diffuse large B‐cell lymphoma (DLBCL) carry a substantial clinical and economic burden. A large portion of these patients require additional therapy beyond first‐line treatment. There is significant unmet need among patients with DLBCL who require additional therapy beyond first‐line treatment. Patients who do not respond to first‐line therapy and are not eligible for transplants have very high health care resource utilization and costs, especially in the first 12 months following initiation of treatment.

Healthcare Resource Utilization and Associated Costs of German Patients with Diffuse Large B-Cell Lymphoma: A Retrospective Health Claims Data Analysis

“…While the treatment duration is very close to our findings, associated costs are much higher, especially in later lines of therapy. Another US study reported average annual costs of $137,156 across therapy lines for patients receiving treatment [17]. Another study concluded that average yearly costs for secondline patients were even higher, and stood at $210,488 [18].…”

Economic burden in non‐Hodgkin lymphoma survivors: The French Lymphoma Study Association SIMONAL cross‐sectional study

“…Of the 4361 French patients alive at their last examination, 3317 were eligible for the survey, and 1671 (50.4%) participated with a median follow-up of 11 years (range, 5-22 years) after the initial treatment of their lymphoma. 19 The study was approved by French legal authorities, namely the Consultative Committee for Data Processing in Health Research and the National Commission on Informatics and Liberty (DR-204-252).…”

“…Its evaluation is difficult because of the nature of the disease and its treatment variability; it is also difficult to compare the results of studies from different countries. [7][8][9][10][11][12][13][14][15][16][17][18][19] To our knowledge, no study has focused on the economic burden in NHL survivors (who have at least 5 years of follow-up after treatment initiation), even though this knowledge is essential. Most survivors are elderly with a potential risk of comorbidity development related to their age and the disease itself (persistent and/or long-term adverse events such as fatigue, relapse, and secondary or new primary cancer).…”

Real‐world patient characteristics, treatment patterns, and treatment outcomes of patients with diffuse large B‐cell lymphoma by line of therapy

“…Although nearly 60% of patients achieve complete remission to 1L treatment, up to 50% could develop refractory or relapsed (R/R) disease, which carries a poor prognosis. 4,5 Though high-dose chemotherapy followed by autologous stem cell transplant (ASCT) is the recommended SOC for eligible patients in the 2L setting based on results from the pivotal PARMA study, real-world SOC in this setting remains less clearly defined. 6,7 The emergence of novel treatment strategies, such as chimeric antigen receptor T-cell (CAR-T) therapy in October 2017, polatuzumab in June 2019, and targeted agents, has provided additional treatment options for patients with R/R DLBCL, but their real-world uptake and outcomes remain poorly understood and quantified.…”