Kite Pharma, Inc., Santa Monica, California, USA
Partnership for Health Analytic Research, LLC, Beverly Hills, California, USA.
Oncologist. 2019 Sep;24(9):1229-1236. doi: 10.1634/theoncologist.2018-0490. Epub 2019 Mar 8.
About one third of patients with diffuse large B-cell lymphoma (DLBCL) relapse after receiving first-line (1L) treatment of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Relapsed patients may then be eligible for second-line (2L) therapy. The study's objective was to examine health care use and costs among treated patients with DLBCL receiving 2L therapy versus those without relapse.
We analyzed Truven Health MarketScan® claims data between 2006 and 2015. Patients (≥18 years of age) had ≥1 DLBCL claim from 1 year before to 90 days after beginning 1L therapy, and comprised those without 2L treatment for ≥2 years (cured controls) versus those who initiated non-R-CHOP chemotherapy after discontinuing 1L therapy (2L cohort). 2L patients were further subgrouped: hematopoietic stem cell transplant (HSCT [yes/no]) and time of relapse (months between 1L and 2L): early (≤3), mid (4-12), and late (>12) relapse. The primary outcome was 1- and 2-year health care costs. Hospitalization rate and length of stay were also measured.
A total of 1,374 patients with DLBCL received R-CHOP and fulfilled all criteria: 1,157 cured controls and 217 2L patients (87 early-relapse, 66 mid-relapse, 64 late-relapse). Twenty-eight percent of 2L patients received HSCT. Charlson Comorbidity Index/mortality risk was higher for 2L patients (4.2 [SD: 3.0]) versus controls (3.8 [2.6]; = .039), as were yearly costs (Year 1: $210,488 [$172,851] vs. $25,044 [$32,441]; < .001 and Year 2: $267,770 [$266,536] vs. $42,272 [$49,281]; < .001). HSCT and chemotherapy were each significant contributors of cost among 2L patients.
DLBCL is resource intensive, particularly for 2L patients. Great need exists for newer, effective therapies for DLBCL that may save lives and reduce costs.
This study identified multiple important drivers of cost in the understudied population of patients with diffuse large B-cell lymphoma (DLBCL) receiving second-line (2L) treatment. Such drivers included hematopoietic stem cell transplant (HSCT) and chemotherapy. Even though HSCT is currently the only curative therapy for DLBCL, less than one third of patients receiving 2L and subsequent treatment underwent transplant, which indicates potential underuse. The variation in chemotherapy regimens suggested a lack of consensus for best practices. Further research focusing on newer and more effective treatment options for DLBCL has the potential to decrease mortality, in addition to reducing the extensive costs related to therapy options such as transplant.
约三分之一的弥漫性大 B 细胞淋巴瘤（DLBCL）患者在接受一线（1L）利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）治疗后会复发。复发患者可能有资格接受二线（2L）治疗。本研究的目的是评估接受二线治疗的 DLBCL 治疗患者与未复发患者的医疗保健使用和成本。
我们分析了 2006 年至 2015 年 Truven Health MarketScan®索赔数据。患者（≥18 岁）在接受 1L 治疗前 1 年至开始 1L 治疗后 90 天内有≥1 例 DLBCL 索赔，包括未接受≥2 年 2L 治疗的患者（治愈对照组）和接受 1L 治疗后停止治疗后开始非 R-CHOP 化疗的患者（2L 队列）。2L 患者进一步分为亚组：造血干细胞移植（HSCT[是/否]）和复发时间（1L 和 2L 之间的月份）：早期（≤3）、中期（4-12）和晚期（>12）。主要结局是 1 年和 2 年的医疗保健成本。还测量了住院率和住院时间。
共有 1374 例接受 R-CHOP 治疗且符合所有标准的 DLBCL 患者：1157 例治愈对照组和 217 例 2L 患者（87 例早期复发、66 例中期复发、64 例晚期复发）。2L 患者中有 28%接受了 HSCT。2L 患者的 Charlson 合并症指数/死亡率风险高于对照组（4.2[SD：3.0]比 3.8[2.6]； = .039），每年的成本也更高（第 1 年：210488 美元[172851 美元]比 25044 美元[32441 美元]； < .001 和第 2 年：267770 美元[266536 美元]比 42272 美元[49281 美元]； < .001）。HSCT 和化疗都是 2L 患者成本的重要因素。
DLBCL 需要大量资源，特别是对 2L 患者而言。对于 DLBCL，迫切需要新的、有效的治疗方法，以挽救生命并降低成本。
本研究确定了接受二线（2L）治疗的弥漫性大 B 细胞淋巴瘤（DLBCL）患者这一研究较少的人群中多项重要的成本驱动因素。这些驱动因素包括造血干细胞移植（HSCT）和化疗。尽管 HSCT 目前是 DLBCL 的唯一治愈疗法，但接受 2L 和后续治疗的患者中只有不到三分之一接受了移植，这表明潜在的使用不足。化疗方案的差异表明缺乏最佳实践的共识。进一步研究专注于 DLBCL 的新型和更有效的治疗方案，有可能降低死亡率，同时降低与移植等治疗方案相关的大量成本。
