Findings from a real-world study suggest the importance of novel agents for improving efficacy outcomes and tolerability in elderly patients with mantle cell lymphoma.
Elderly U.S Medicare beneficiaries with mantle cell lymphoma (MCL) experienced high hospitalization rates, substantial healthcare costs, and poor overall survival (OS) outcomes, according to findings from a real-world study published in Leukemia & Lymphoma.
The median OS was 57.6 months from initial MCL diagnosis and 53.5 months from initiation of frontline treatment. Additionally, the median OS was 22.0 months with second-line, 11.8 months with third-line, and 7.8 months with fourth-line therapies, respectively. The 1-year and 3-year survival rates were 81.3% and 60.6% following frontline treatment initiation, respectively, and the corresponding rates were 63.8% and 38.0% for those who received second-line treatment or later.
Overall, 51.8% of patients underwent hospitalization due to any cause, with 42.2% of instances being related to MCL. The rates of hospice care were 21.7% in the second line and beyond, 33.8% in the third line and beyond, and 41.0% in the fourth line and beyond.
Over 80% of health care costs were related to services for an MCL diagnosis across all treatment lines. Total health care costs related to MCL at 12 months after beginning study treatment were $114,369 for those who received therapy in at least the first line, $113,768 in the second line, $113,116 in the third line, and $115,883 in the third line.
In total, MCL-related prescription drug costs including Part B drugs—those that physicians had administered—and Part D drugs—those with pharmacy costs—were $73,398 for those who received treatment in at least the first line, $75,873 in the second line, $68,871 in the third line, and $61,910 in the fourth line. In the first-line setting, 87% ($63,749) of drug costs were for physician-administered Part B drugs compared with 13% ($9650) for Part D drugs. However, investigators noted that the price of Part D drugs comprised between 55% to 65% of prescription drug costs related to MCL, including $41,925 in the second line and later, $41,003 in the third line and later, and $40,381 in the fourth line and later.
“This descriptive study of a national sample of Medicare beneficiaries being treated for MCL provides important insights into real-world treatment patterns, health care resource utilization, [and] costs and survival among older adults in the frontline and relapsed/refractory settings,” the study authors wrote. “These data point to a clear unmet need and the importance of novel agents and treatment modalities with higher efficacy and better tolerability to be used alone or in combination to improve outcomes in elderly patients with MCL.”
Investigators of this real-world study analyzed Medicare claims from 2009 to 2019 to determine treatment patterns, health care resources utilization, costs, and survival among 3664 geriatric patients receiving frontline treatment for MCL. Key sociodemographic and clinical characteristics of interest included age, gender, low-income subsidy status, region, and metropolitan status.
Patients who had continuous fee-for-service Medicare Parts A, B, and D coverage for at least 1 year before and after treatment initiation were eligible for inclusion in the study. Additional eligibility criteria included being at least 66 years old and having evidence of an identifiable MCL-indicated treatment following initial MCL diagnosis.
The median follow-up was 2.8 years. Additionally, 5.6% of patients underwent stem cell transplantation (SCT), which included autologous SCT in 5.3%.
The median patient age across the frontline and relapsed/refractory settings was 75 years, and more than 25% of the population was 80 years or older. Across the frontline and relapsed/refractory setting cohorts, male patients made up anywhere from 66.1% to 69.0% of the population, and 92.1% to 93.7% of patients were White. Additionally, most patients lived in an urban area.
In the frontline setting, 55.5% of patients received a bendamustine (Treanda)–based regimen; the most common regimen was bendamustine/Rituximab (Rituxan; 50.1%). Other, less common therapies in the frontline setting included cyclophosphamide, vincristine, and prednisone (3.5%); covalent Bruton tyrosine kinase (BTK) inhibitors (4.2%); and bortezomib (Velcade)-based regimens (3.9%). Targeted therapies including covalent BTK inhibitor-related regimens, bortezomib-based regimens, and lenalidomide (Revlimid)–based regimens were more frequently administered to patients in the relapsed/refractory setting.
Squires P, Puckett J, Ryland KE, et al. Assessing unmet need among elderly Medicare beneficiaries with mantle cell lymphoma: an analysis of treatment patterns, survival, healthcare resource utilization, and costs. Leuk Lymphoma. Published online July 27, 2023. doi:10.1080/10428194.2023.2234525