Patients With DLBCL, FL Face Increasing Economic Burden

August 10, 2018

DLBCL and FL patients experience considerable economic burden during the first year after diagnosis.

Patients diagnosed with diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) experience a considerable economic burden during the first year after diagnosis, according to the results of a study published recently in Future Medicine.

According to the study, chemoimmunotherapy is playing an increasing role in the initial treatment of DLBCL and FL.

“Costs of DLBCL and FL chemoimmunotherapy administration are major contributors to the overall costs in each cohort,” wrote Vicki A. Morrison, MD, of the University of Minnesota, and colleagues. “Additionally, costs unrelated to DLBCL and FL-particularly in the inpatient and nonphysician office outpatient settings-were also major contributors.”

Morrison and colleagues conducted the observational study to look at healthcare utilization and costs associated with a diagnosis of DLBCL or FL in the United States. The study included 1,267 patients with DLBCL and 1,595 patients with FL, taken from the Optum claims database.

The Optum claims database includes data from 1993 to the present on more than 111 million patients from across the United States. The database includes information on pharmacy claims, lab results, mental health claims, and commercial and Medicare enrollment information.

During follow-up, the mean per-patient, per-month (PPPM) cost was $11,890 for DLBCL and $10,460 for FL. For DLBCL, the majority of patients only received one line of treatment during the follow-up period. The median duration of treatment for first-line therapy was 4.2 months. For FL, less than one in five patients received more than one line of treatment. The median duration of treatment for first-line therapy was 4.5 months. Treatment with rituximab-based regimens were the dominant treatment for patients with DLBCL and FL.

The majority of patients with DLBCL and FL had one or more all-cause outpatient doctor’s office visit or other outpatient visit during the follow-up period. In both groups, the majority of these visits were related to their lymphoma.

Inpatient admissions were common during follow-up, with 65.8% of patients with DLBCL and 51% of patients with FL having one or more inpatient admissions. The rate of inpatient admissions, number of inpatient admissions, and length of stay decreased from year 1 to year 2.

Finally, more than half of patients in both groups had one or more emergency department visits.

Healthcare costs and utilization decreased following the first year after diagnosis. For patients with DLBCL, lymphoma-related costs made up almost 60% of the total mean DLBCL-related medical costs during year 1. This percentage decreased to 37% in year 2. Similarly, for patients with FL, FL-related costs made up about 65% of mean medical costs during year 1, but decreased to 55% in year 2.

“Since our study was conducted, there have been changes in the treatment landscape of DLBCL with the approval of a chimeric antigen receptor T-cell therapy, axicabtagene ciloleucel,” the researchers noted. “This represents a novel treatment option for relapsed or refractory DLBCL patients, and is expected to impact the treatment cost of DLBCL. Among eligible patients, the average potential annual budget impact when using the cost of axicabtagene ciloleucel infusion was estimated to be $184,000 per patient.”

As treatment of both DLBCL and FL evolves, the researchers noted that “economic impact and healthcare utilization need to be further investigated.”