Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.
Analysis Group Inc, Montreal, Quebec, Canada.
Clin Ther. 2021 Aug;43(8):1285-1299. doi: 10.1016/j.clinthera.2021.06.012. Epub 2021 Jul 29.
This study assessed treatment patterns in patients with mantle cell lymphoma (MCL) and compared health care resource utilization (HRU) and costs of ibrutinib with or without rituximab (I ± R) versus chemoimmunotherapy (CIT) in patients with relapsed/refractory MCL.
For this retrospective cohort study, adults with MCL observed between May 13, 2013, and June 30, 2019, were identified using Optum's de-identified Clinformatics Data Mart Database. Treatment patterns were described among patients who received ≥1 line of therapy (LOT). HRU and costs (payer's perspective) were compared between patients treated with I ± R and CIT in the second or later line (2L+) of therapy. To account for differences in baseline characteristics between the 2 cohorts, inverse probability of treatment weighting was used. Monthly HRU and costs starting from I ± R or CIT treatment initiation (index date) were compared during the first Oncology Care Model (OCM) episode (ie, first 6 months) postindex and during the observed duration of I ± R or CIT LOT (index LOT) using rate ratios (RRs) and mean monthly cost differences (MMCDs), respectively.
Among 1346 patients with ≥1 LOT (median follow-up, 15.3 months), 870 (64.6%) were treated with CIT in the first line. Only 348 (25.9%) had a 2L of therapy, of whom 110 (31.6%) were treated with CIT and 98 (28.2%) with an ibrutinib-based therapy. A total of 300 patients were included for the comparison of HRU and costs between 2L+ I ± R and 2L+ CIT. The weighted cohorts (after inverse probability of treatment weighting) included 149 patients treated with I ± R (mean age, 71.6 years; 73.7% men) and 151 treated with CIT (mean age, 71.5 years; 76.2% men). During the first OCM episode and during the index LOT, the I ± R cohort had significantly fewer monthly days with outpatient services compared to the CIT cohort (OCM, RR = 0.63 [P < 0.001]; index LOT, RR = 0.73 [P = 0.004]). Compared to the CIT cohort, the I ± R cohort incurred significantly higher monthly pharmacy costs (MMCDs: OCM, 9938 US dollars [USD] [P < 0.001]; index LOT, 8920 USD [P < 0.001]) that were fully offset by lower monthly medical costs (MMCDs: OCM, -19,373 USD [P < 0.001]; index LOT, -13,548 USD [P < 0.001]), resulting in monthly total health care cost savings (MMCDs, OCM, -9435 USD [P < 0.001]; index LOT , -4628 USD [P = 0.01]).
Over a median follow-up of 15.3 months, most patients with MCL were treated with CIT in the first line, and only one fourth had a 2L therapy. Patients with relapsed/refractory MCL treated with I ± R had significantly fewer days with outpatient services and lower monthly total health care costs versus those treated with CIT during the first OCM episode and the index LOT.
本研究评估了套细胞淋巴瘤（MCL）患者的治疗模式，并比较了复发/难治性 MCL 患者接受伊布替尼联合利妥昔单抗（I ± R）与化疗免疫治疗（CIT）二线或以上治疗的健康护理资源利用（HRU）和成本。
本回顾性队列研究使用 Optum 的去识别 Clinformatics Data Mart 数据库，于 2013 年 5 月 13 日至 2019 年 6 月 30 日期间观察到的成年人中确定 MCL 患者。描述了接受至少 1 线治疗（LOT）的患者的治疗模式。比较二线或以上治疗（2L+）中接受 I ± R 和 CIT 治疗的患者的 HRU 和成本（支付方视角）。为了考虑两个队列之间基线特征的差异，使用了逆概率治疗加权。自 I ± R 或 CIT 治疗开始（索引日期）起，比较了第一个肿瘤学照护模式（OCM）期间（即首次 6 个月）和 I ± R 或 CIT LOT 期间（索引 LOT）的每月 HRU 和成本，分别使用比率比（RR）和每月平均成本差异（MMCD）。
在 1346 名接受至少 1 线 LOT（中位随访时间为 15.3 个月）的患者中，870 名（64.6%）在一线接受 CIT 治疗。仅有 348 名（25.9%）接受二线治疗，其中 110 名（31.6%）接受 CIT 治疗，98 名（28.2%）接受伊布替尼为基础的治疗。共有 300 名患者被纳入 2L+I ± R 和 2L+CIT 之间 HRU 和成本的比较。经逆概率治疗加权后的加权队列（n = 300）包括 149 名接受 I ± R 治疗的患者（平均年龄 71.6 岁；73.7%为男性）和 151 名接受 CIT 治疗的患者（平均年龄 71.5 岁；76.2%为男性）。在第一个 OCM 期间和索引 LOT 期间，与 CIT 队列相比，I ± R 队列的门诊服务每月天数明显较少（OCM：RR = 0.63 [P < 0.001]；索引 LOT：RR = 0.73 [P = 0.004]）。与 CIT 队列相比，I ± R 队列的每月药房成本明显较高（MMCD：OCM：9938 美元[USD] [P < 0.001]；索引 LOT：8920 美元[P < 0.001]），但每月医疗成本明显较低（MMCD：OCM：-19373 美元[P < 0.001]；索引 LOT：-13548 美元[P < 0.001]），导致每月总健康护理成本节省（MMCD：OCM：-9435 美元[P < 0.001]；索引 LOT：-4628 美元[P = 0.01]）。
在中位随访 15.3 个月期间，大多数 MCL 患者在一线接受 CIT 治疗，只有四分之一的患者接受二线治疗。在第一个 OCM 期间和索引 LOT 期间，与接受 CIT 治疗的患者相比，接受伊布替尼联合利妥昔单抗治疗的复发/难治性 MCL 患者的门诊服务天数明显减少，每月总健康护理成本明显降低。
