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. 2023 Apr 30;30(5):4663-4676.
doi: 10.3390/curroncol30050352.

Estimating the Burden of Illness of Relapsed Follicular Lymphoma and Marginal Zone Lymphoma in Ontario, Canada

John Kuruvilla  1   2 , Emmanuel M Ewara  3 , Julia Elia-Pacitti  4 , Ryan Ng  5 , Maria Eberg  5 , Atif Kukaswadia  6 , Arushi Sharma  7
Affiliations

Estimating the Burden of Illness of Relapsed Follicular Lymphoma and Marginal Zone Lymphoma in Ontario, Canada

John Kuruvilla et al. Curr Oncol. .

Abstract

Background: Many patients with advanced follicular lymphoma (FL) and marginal zone lymphoma (MZL) relapse after first-line chemotherapy.

Objective: To examine healthcare resource utilization (HCRU) and cost, treatment patterns, progression, and survival of patients with FL and MZL who relapse after first-line treatment, in Ontario, Canada.

Methods: A retrospective, administrative data study identified patients with relapsed FL and MZL (1 January 2005-31 December 2018). Patients were followed for up to three years post relapse to assess HCRU, healthcare costs, time to next treatment (TTNT), and overall survival (OS), stratified by first- and second-line treatment.

Results: The study identified 285 FL and 68 MZL cases who relapsed after first-line treatment. Average duration of first-line treatment was 12.4 and 13.4 months for FL and MZL patients, respectively. Drug (35.9%) and cancer clinic costs (28.1%) were major contributors to higher costs in year 1. Three-year OS was 83.9% after FL and 74.2% after MZL relapse. No statistically significant differences were observed in TTNT and OS between patients with FL who received R-CHOP/R-CVP/BR in the first line only versus both the first- and second- line. A total of 31% of FL and 34% of MZL patients progressed to third-line treatment within three years of initial relapse.

Conclusion: Relapsing and remitting nature of FL and MZL in a subset of patients results in substantial burden to patients and the healthcare system.

Keywords: burden of illness; costs; epidemiology; follicular lymphoma; marginal zone lymphoma.

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Conflict of interest statement

Emmanuel Ewara is an employee of Janssen Inc. and a stockholder of Johnson & Johnson. Julia Pacitti is an employee of Janssen Inc. and a stockholder of Johnson & Johnson. Ryan Ng, Maria Eberg, Atif Kukaswadia, and Arushi Sharma are employees of IQVIA Solutions Canada Inc. IQVIA is a contract research organization which received consulting fees from Janssen Inc.

Figures

Figure 1
Figure 1
Healthcare resource utilization (average number of visits) in the three years post relapse for follicular lymphoma (FL) and marginal zone lymphoma (MZL) relapse cohorts, Ontario, Canada, 2005–2018. Abbreviations: FL: follicular lymphoma; MZL: marginal zone lymphoma; GP: general practitioner; ED: emergency department.
Figure 2
Figure 2
Proportion of total cost by healthcare service in the three years post relapse for follicular lymphoma and marginal zone lymphoma cohorts, Ontario, Canada, 2005–2018. Abbreviations FL: follicular lymphoma; MZL: marginal zone lymphoma; NDFP: New Drug Funding Program; ODB: Ontario Drug Benefit.
Figure 3
Figure 3
Proportion of total cost by healthcare service in the three years post relapse for the follicular lymphoma cohort stratified by treatment received in the first and second line, Ontario, Canada, 2005–2018. Abbreviations: BR: bendamustine plus rituximab; CHOP: cyclophosphamide, doxorubicin, vincristine, and oral prednisone; CVP: cyclophosphamide, vincristine, and oral prednisone; ED: emergency department; FL: follicular lymphoma; LoT: line of treatment; MZL: marginal zone lymphoma; R-mono: rituximab monotherapy; NDFP: New Drug Funding Program; ODB: Ontario Drug Benefit.
Figure 4
Figure 4
(online only). Cumulative incidence function (95%CI) of all-cause mortality and time to next treatment for (A) all FL relapse patients, (B) all MZL relapse patients and (C) all FL relapse patients stratified by regimen received in the first- and second-line, Ontario, Canada, 2005–2018. Abbreviations: BR: bendamustine plus rituximab; CHOP: cyclophosphamide, doxorubicin, vincristine, and oral prednisone; CVP: cyclophosphamide, vincristine, and oral prednisone; ED: emergency department; FL: follicular lymphoma; LoT: line of treatment; MZL: marginal zone lymphoma; R-mono: rituximab monotherapy.
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References

    1. Brenner D., Poirier A., Smith L. Canadian Cancer Statistics Advisory Committee in collaboration with the Canadian Cancer Society: Statistics Canada and the Public Health Agency of Canada. Can. Cancer Soc. 2021
    1. Ma S. Risk Factors of Follicular Lymphoma. Expert Opin. Med. Diagn. 2012;6:323–333. doi: 10.1517/17530059.2012.686996. - DOI - PMC - PubMed
    1. Cerhan J.R., Habermann T.M. Epidemiology of marginal zone lymphoma. Ann. Lymphoma. 2021;5:1. doi: 10.21037/aol-20-28. - DOI - PMC - PubMed
    1. Ye X., Mahmud S., Skrabek P., Lix L., Johnston J.B. Long-term time trends in incidence, survival and mortality of lymphomas by subtype among adults in Manitoba, Canada: A population-based study using cancer registry data. BMJ. Open. 2017;7:e015106. doi: 10.1136/bmjopen-2016-015106. - DOI - PMC - PubMed
    1. Rathore B., Kadin M.E. Hodgkin’s lymphoma therapy: Past, present, and future. Expert Opin. Pharm. 2010;11:2891–2906. doi: 10.1517/14656566.2010.515979. - DOI - PMC - PubMed

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