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.

Keywords: Costs; Diffuse B-cell lymphoma; Health care resource utilization; Patient characteristics; Treatment patterns.

Figure 1

Patient disposition. ¹DLBCL can only be administratively differentiated from other morphologically similar lymphomas using ICD‐10‐CM codes, which have been available since October 1, 2015, in the U.S. ²Including codes referring to nonidentifiable agents (e.g., ICD‐9‐CM: V58.11, ICD‐10‐CM: Z51.11, Current Procedural Terminology: 96401, Healthcare Common Procedure Coding System: J8999), 2,450 incident patients and 798 prevalent patients had a 1L observed. Because this study focuses on agents included in each line of therapies, patients with nonidentifiable agents only were not selected. Abbreviations: 1L, first line; DLBCL, diffuse large B‐cell lymphoma; ICD‐9‐CM, International Classification of Diseases, Ninth Revision, Clinical Modification; ICD‐10‐CM, International Classification of Diseases, Tenth Revision, Clinical Modification; PMBCL, primary mediastinal large B‐cell lymphoma.

Figure 2

(A): Most frequently observed treatments during the observation period for patients with incident diffuse large B‐cell lymphoma (DLBCL). *, In addition to BR, R‐CEOP (rituximab plus cyclophosphamide, etoposide, vincristine, and prednisone) was also used in 4L by one person. (B): Most frequently observed treatments during the observation period for patients with prevalent DLBCL. Abbreviations: 1L, first line; 2L, second line; 3L, third line; 4L, fourth line; BR, bendamustine plus rituximab; R‐CHOP, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone; R‐ICE, rituximab plus ifosfamide, carboplatin, and etoposide phosphate.

Figure 3

Health care costs per patient per year during the observation period for patients with diffuse large B‐cell lymphoma treated with at least one line of therapy. Abbreviations: ER, emergency room; IP, inpatient; OP, outpatient.