Center for Outcomes Research, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Center for Pharmacoepidemiology & Pharmacoeconomic Research, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA.
J Comp Eff Res. 2019 Apr;8(6):393-402. doi: 10.2217/cer-2018-0094. Epub 2019 Mar 11.
Diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) are common types of non-Hodgkin's lymphoma, and real-world evidence continues to be lacking for healthcare costs and utilization among DLBCL and FL patients. Our study aims to describe medical and pharmacy costs and health resource utilization and to characterize longitudinal treatment patterns among these patients.
A retrospective observational study was performed among adult patients with DLBCL or FL using the US MarketScan (Truven) administrative claims data from 1 January 2007 to 31 December 2015. Diagnoses of DLBCL and FL were based upon ICD-9 codes. Identifications of treatment lines involved 30 lymphoma-specific anticancer systemic agents. Direct healthcare costs and utilizations were computed in the 1-year postdiagnosis period. Generalized linear models with a gamma link were used to compare healthcare costs between therapies with and without rituximab.
A total of 2767 DLBCL and 5989 FL patients received frontline therapy. The majority received treatment within 3 months after initial diagnosis (DLBCL 79.9% and FL 62.4%) and were treated with rituximab or bendamustine either alone or in combination (DLBCL 67.4% and FL 84.7%). The total healthcare costs were US $15,555 and $10,192 per patient per month within 1 year following their initial diagnosis for DLBCL and FL, respectively. The medical costs were nearly twice as much as the drug costs for DLBCL patients. Both DLBCL and FL patients receiving rituximab had higher pharmacy costs but lower medical costs (p < 0.001). During the first year following initial diagnosis, the resource utilization (per patient per month) of DLBCL patients included 0.21 inpatient admissions, 0.26 radiation therapy, 2.63 outpatient or office visits, 0.18 emergency room visits, 0.06 intensive care unit admissions and 0.10 stem cell transplantation. FL patients occupied less health resources than DLBCL patients.
The healthcare costs and health resources utilized were considerable in non-Hodgkin's lymphoma, especially DLBCL patients.
弥漫性大 B 细胞淋巴瘤（DLBCL）和滤泡性淋巴瘤（FL）是非霍奇金淋巴瘤的常见类型，DLBCL 和 FL 患者的医疗保健成本和利用情况仍缺乏真实世界证据。本研究旨在描述这些患者的医疗和药物成本以及健康资源的利用情况，并描述其纵向治疗模式。
采用美国 MarketScan（Truven）行政索赔数据，对 2007 年 1 月 1 日至 2015 年 12 月 31 日期间诊断为 DLBCL 或 FL 的成年患者进行回顾性观察性研究。根据 ICD-9 代码诊断为 DLBCL 和 FL。鉴定的治疗线涉及 30 种淋巴瘤特异性抗癌系统药物。在诊断后 1 年内计算直接医疗成本和利用情况。使用具有伽玛链接的广义线性模型比较有无利妥昔单抗的治疗方法之间的医疗保健成本。
共有 2767 例 DLBCL 和 5989 例 FL 患者接受了一线治疗。大多数患者在初始诊断后 3 个月内接受治疗（DLBCL 为 79.9%，FL 为 62.4%），并单独或联合使用利妥昔单抗或苯达莫司汀治疗（DLBCL 为 67.4%，FL 为 84.7%）。DLBCL 和 FL 患者在初始诊断后 1 年内每月的总医疗保健费用分别为 15555 美元和 10192 美元。DLBCL 患者的医疗费用几乎是药物费用的两倍。接受利妥昔单抗治疗的 DLBCL 和 FL 患者的药物成本更高，但医疗成本更低（p<0.001）。在初始诊断后的第一年，DLBCL 患者的资源利用率（每位患者每月）包括 0.21 次住院、0.26 次放疗、2.63 次门诊或就诊、0.18 次急诊、0.06 次重症监护病房入院和 0.10 次干细胞移植。FL 患者占用的健康资源少于 DLBCL 患者。
非霍奇金淋巴瘤，尤其是 DLBCL 患者的医疗保健成本和利用的健康资源相当可观。
