Merck & Co., Inc., Kenilworth, New Jersey, USA.
Groupe d'analyse, Ltée, Montréal, Québec, Canada.
Oncologist. 2021 May;26(5):e817-e826. doi: 10.1002/onco.13721. Epub 2021 Mar 15.
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.
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.
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.
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.
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.
弥漫性大 B 细胞淋巴瘤（DLBCL）是美国最常见的非霍奇金淋巴瘤亚型，但目前的真实世界数据有限。本研究旨在描述美国接受治疗的 DLBCL 患者的真实特征、治疗模式、医疗资源利用（HRU）和医疗保健费用。
使用 Optum Clinformatics Data Mart 数据库（2013 年 1 月至 2018 年 3 月）进行回顾性研究。2015 年 10 月后，国际疾病分类，第十次修订，临床修正诊断为 DLBCL，且无先前国际疾病分类，第九次修订，临床修正诊断为未特指的 DLBCL 或原发性纵隔大 B 细胞淋巴瘤的患者被归类为初发；有这些代码的患者被归类为现患。适应性算法确定了治疗线（例如一线 [1L]）。≥1L 的患者按每位患者每年（PPPY）计算全因 HRU 和费用。
在 1877 名初发和 651 名现患≥1L 的患者中，中位年龄为 72 岁，46%为女性。在初发患者中，22.6%至少接受了 2 线（2L）治疗，而 38.4%的现患患者接受了≥2L 治疗。最常见的一线治疗是利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）。初发患者的住院和门诊（OP）就诊次数分别为 1.3 次和 42.0 次 PPPY，而现患患者的就诊次数分别为 0.8 次和 31.3 次 PPPY。初发和现患患者的总费用分别为 137156 美元和 81669 美元 PPPY。OP 费用是总费用的主要驱动因素，为 88202 美元 PPPY，这一费用在第一年更高。
本研究表明，很大一部分患者在接受 1L 治疗后需要额外的治疗来治疗 DLBCL，并强调了 DLBCL 患者的巨大经济负担，特别是在诊断后的第一年。
诊断为弥漫性大 B 细胞淋巴瘤（DLBCL）的患者具有相当大的临床和经济负担。这些患者中有很大一部分需要在一线治疗之外进行额外的治疗。需要在一线治疗之外进行额外治疗的 DLBCL 患者存在显著的未满足需求。对于未对一线治疗产生应答且不符合移植条件的患者，其医疗资源利用率和费用非常高，尤其是在开始治疗后的 12 个月内。
