College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN, USA.
Genentech, Inc, South San Francisco, CA, USA.
J Med Econ. 2024 Jan-Dec;27(1):738-745. doi: 10.1080/13696998.2024.2349472. Epub 2024 May 6.
There are multiple recently approved treatments and a lack of clear standard-of-care therapies for relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). While total cost of care (TCC) by the number of lines of therapy (LoTs) has been evaluated, more recent cost estimates using real-world data are needed. This analysis assessed real-world TCC of R/R DLBCL therapies by LoT using the IQVIA PharMetrics Plus database (1 January 2015-31 December 2021), in US patients aged ≥18 years treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or an R-CHOP-like regimen as first-line therapy.
Treatment costs and resources in the R/R setting were assessed by LoT. A sensitivity analysis identified any potential confounding of the results caused by the impact of the COVID-19 pandemic on healthcare utilization and costs. Overall, 310 patients receiving a second- or later-line treatment were included; baseline characteristics were similar across LoTs. Inpatient costs represented the highest percentage of total costs, followed by outpatient and pharmacy costs.
Mean TCC per-patient-per-month generally increased by LoT ($40,604, $48,630, and $59,499 for second-, third- and fourth-line treatments, respectively). Costs were highest for fourth-line treatment for all healthcare resource utilization categories. Sensitivity analysis findings were consistent with the overall analysis, indicating results were not confounded by the COVID-19 pandemic.
There was potential misclassification of LoT; claims data were processed through an algorithm, possibly introducing errors. A low number of patients met the inclusion criteria. Patients who switched insurance plans, had insurance terminated, or whose enrollment period met the end of data availability may have had truncated follow-up, potentially resulting in underestimated costs.
Total healthcare costs increased with each additional LoT in the R/R DLBCL setting. Further improvements of first-line treatments that reduce the need for subsequent LoTs would potentially lessen the economic burden of DLBCL.
复发/难治性（R/R）弥漫性大 B 细胞淋巴瘤（DLBCL）有多种最近批准的治疗方法，但缺乏明确的标准治疗方法。虽然已经评估了按治疗线数（LoTs）计算的总医疗成本（TCC），但需要使用真实世界数据进行更近期的成本估算。本分析使用 IQVIA PharMetrics Plus 数据库（2015 年 1 月 1 日至 2021 年 12 月 31 日），评估了 R/R DLBCL 治疗中按 LoTs 计算的真实世界 TCC，纳入了在接受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）或 R-CHOP 样方案作为一线治疗的年龄≥18 岁的美国患者。
按 LoTs 评估 R/R 环境下的治疗成本和资源。敏感性分析确定了 COVID-19 大流行对医疗保健利用和成本的影响对结果可能造成的任何潜在混杂。共有 310 名接受二线或以上治疗的患者纳入研究；各 LoT 间基线特征相似。住院费用占总费用的比例最高，其次是门诊和药房费用。
每位患者每月的 TCC 平均值随 LoT 增加而增加（二线、三线和四线治疗的费用分别为 40604 美元、48630 美元和 59499 美元）。所有医疗资源利用类别的四线治疗费用最高。敏感性分析结果与总体分析一致，表明结果不受 COVID-19 大流行的影响。
LoT 可能存在潜在的分类错误；索赔数据是通过算法处理的，可能会引入错误。符合纳入标准的患者人数较少。转换保险计划、保险终止或登记期在数据可用结束日期之前的患者可能会随访时间缩短，从而导致成本被低估。
在 R/R DLBCL 环境中，每增加一个 LoT，总医疗成本都会增加。进一步改善一线治疗方法，减少对后续 LoTs 的需求，可能会减轻 DLBCL 的经济负担。
