Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug 18;15(8):e0237509.
doi: 10.1371/journal.pone.0237509. eCollection 2020.

Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma

Saaya Tsutsué  1 , Kensei Tobinai  2 , Jingbo Yi  3 , Bruce Crawford  3
Affiliations

Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma

Saaya Tsutsué et al. PLoS One. .

Abstract

Limited data are available regarding treatment patterns, healthcare resource utilization (HCRU), treatment costs and clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL) in Japan. This retrospective database study analyzed the Medical Data Vision database for DLBCL patients who received treatment during the identification period from October 1 2008 to December 31 2017. Among 6,965 eligible DLBCL patients, 5,541 patients (79.6%) received first-line (1L) rituximab (R)-based therapy, and then were gradually switched to chemotherapy without R in subsequent lines of therapy. In each treatment regimen, 1L treatment cost was the highest among all lines of therapy. The major cost drivers i.e. total direct medical costs until death or censoring across all regimens and lines of therapy were from the 1L regimen and inpatient costs. During the follow-up period, DLBCL patients who received a 1L R-CHOP regimen achieved the highest survival rate and longest time-to-next-treatment, with a relatively low mean treatment cost due to lower inpatient healthcare resource utilization and fewer lines of therapy compared to other 1L regimens. Our retrospective analysis of clinical practices in Japanese DLBCL patients demonstrated that 1L treatment and inpatient costs were major cost contributors and that the use of 1L R-CHOP was associated with better clinical outcomes at a relatively low mean treatment cost.

PubMed Disclaimer

Conflict of interest statement

ST is current employee of Celgene KK. BC and JY are current employee of Syneos Health Japan. KT served as a consultant for Mundi Pharma, Taked Pharmaceutaical, Celgene, Ono pharmaceutical, Janssen Pharmaceutical, HUYA Bioscience, Zenyaku Kogyo, Daiichi Sankyo, Eizai, Chugai Pharmaceutical, outside of the submitted work. KT received honaria from Solasia, Mundi Pharma, Takeda Pharmaceutaical, Ono pharmaceutical, Yakult, Meiji Seika, Janssen Pharmaceutical, BMS, HUYA Bioscience, Zenyaku Kogyo, DS, Eizai, C 44 hugai Pharmaceutical, Verastem, Kyowa Kirin, outside of the submitted work. KT received research funding from Mundi Pharma, Takeda Pharmaceutaical, Celgene, Ono pharmaceutical, Yakult, Janssen Pharmaceutical, Eizai, Chugai Pharmaceutical, outside of the submitted work. There are no patents, products in development, or marketed products to declare for the target regimens of this study. This does not alter our adherence to all PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Patient selection for inclusion in analysis (identification period October 1 2008 to December 31 2017).
DLBCL: diffuse large B-cell lymphoma; ICD-10: International Classification of Diseases Revision 10.
Fig 2
Fig 2. DLBCL-related HCRU by 1L treatment.
(A) Average total days of inpatient stay (ANOVA, p<0.0001). (B) Average number of hospitalizations (p<0.0001). (C) Average number of outpatient visits (p<0.0001). (D) Average overall treatment duration (p<0.0001). Error bars indicate 95% confidence limit.
Fig 3
Fig 3. Total cost during follow-up.
Cost in USD; error bars indicate 95% confidence limit.
Fig 4
Fig 4. DLBCL-related costs by 1L treatment (USD; error bars indicate 95% confidence limit).
(A) Average inpatient cost (p<0.0001). (B) Average outpatient cost (p<0.0001). (C) Average total cancer treatment cost (p<0.0001). (D) Average stem cell transplant cost (p = 0.0010; no data available for R + bendamustine and other therapy without R).
Fig 5
Fig 5. Kaplan-Meier plots for overall survival.
(A) Overall survival and stratified by (B) 1L regimen group, (C) patient age, (D) gender, and (E) CCI score. CCI: Charlson Comorbidity Index; OS: overall survival; R: rituximab; R-CHOP: rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.
Fig 6
Fig 6. Kaplan-Meier plots for time to next treatment.
(A) Overall TTNT and stratified by (B) 1L regimen group, (C) patient age, (D) gender, and (E) CCI score. CCI: Charlson Comorbidity Index; R: rituximab; R-CHOP: rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone; TTNT: time to next treatment.
See this image and copyright information in PMC

References

    1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, et al. (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136: E359–386. 10.1002/ijc.29210 - DOI - PubMed
    1. Chihara D, Ito H, Matsuda T, Shibata A, Katsumi A, et al. (2014) Differences in incidence and trends of haematological malignancies in Japan and the United States. Br J Haematol 164: 536–545. 10.1111/bjh.12659 - DOI - PMC - PubMed
    1. Chihara D, Nastoupil LJ, Williams JN, Lee P, Koff JL, et al. (2015) New insights into the epidemiology of non-Hodgkin lymphoma and implications for therapy. Expert Rev Anticancer Ther 15: 531–544. 10.1586/14737140.2015.1023712 - DOI - PMC - PubMed
    1. Chihara D, Ito H, Izutsu K, Hattori M, Nishino Y, et al. (2015) Advance and stagnation in the treatment of patients with lymphoma and myeloma: Analysis using population-based cancer registry data in Japan from 1993 to 2006. Int J Cancer 137: 1217–1223. 10.1002/ijc.29477 - DOI - PubMed
    1. Seki R, Ohshima K, Nagafuji K, Fujisaki T, Uike N, et al. (2010) Rituximab in combination with CHOP chemotherapy for the treatment of diffuse large B cell lymphoma in Japan: a retrospective analysis of 1,057 cases from Kyushu Lymphoma Study Group. Int J Hematol 91: 258–266. 10.1007/s12185-009-0475-2 - DOI - PubMed

Publication types

MeSH terms