Tsutsué Saaya, Makita Shinichi, Asou Hiroya, Mathew Anila, Kado Yuki, Idehara Koki, Kim Seok-Won, Ainiwaer Dilinuer
Gilead Sciences Japan, Tokyo, Japan.
National Cancer Center Hospital, Tokyo, Japan.
BMC Health Serv Res. 2025 Jan 27;25(1):149. doi: 10.1186/s12913-025-12306-7.
This study was conducted using a nationwide health care database of Japan between 1 April 2008 and 30 September 2022 to evaluate the economic burden on patients with mantle cell lymphoma (MCL). Structural equation modeling (SEM) is an advanced multivariate analysis framework used to assess the relationships between observed and latent variables within predefined causal models. In this study, SEM was employed to identify cost drivers and estimate variables related to MCL treatment cost. A total of 2,838 patients having at least one confirmed diagnosis of MCL participated in this study. As for the index regimen, a combination of bendamustine rituximab was the most frequently used (n = 328), followed by rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisolone-like regimen (n = 112), and others. The median of total health care cost (unadjusted and adjusted) were 32,228 USD and 31,918 USD, respectively. The mean (SD) of the frequency of bleeding treatment was 23 (35) per year, and that of outpatient visits was 19 (12) per year. SEM analysis revealed Bruton tyrosine kinase inhibitor-based treatment as a cost driver (β: 0.398 [0.340; 0.457], p < 0.001). Key health care resource utilization (HCRU) factors associated with an increased cost were the total length of hospitalization (β: 0.598 [0.551; 0.646], p < 0.001) and number of outpatient visits (β: 0.132 [0.083; 0.180], p < 0.001). This real-world study delivers insights for optimizing MCL care in Japan.
本研究利用日本全国医疗保健数据库，在2008年4月1日至2022年9月30日期间开展，以评估套细胞淋巴瘤（MCL）患者的经济负担。结构方程模型（SEM）是一种先进的多变量分析框架，用于评估预定义因果模型中观测变量和潜在变量之间的关系。在本研究中，采用SEM来确定成本驱动因素并估计与MCL治疗成本相关的变量。共有2838名至少有一次确诊MCL的患者参与了本研究。至于初始治疗方案，苯达莫司汀联合利妥昔单抗的组合使用最为频繁（n = 328），其次是利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松龙样方案（n = 112），以及其他方案。总医疗保健成本（未调整和调整后）的中位数分别为32,228美元和31,918美元。出血治疗频率的平均值（标准差）为每年23次（35次），门诊就诊频率的平均值（标准差）为每年19次（12次）。SEM分析显示，基于布鲁顿酪氨酸激酶抑制剂的治疗是成本驱动因素（β：0.398 [0.340；0.457]，p < 0.001）。与成本增加相关的关键医疗保健资源利用（HCRU）因素是住院总时长（β：0.598 [0.551；0.646]，p < 0.001）和门诊就诊次数（β：0.132 [0.083；0.180]，p < 0.001）。这项真实世界研究为优化日本的MCL护理提供了见解。
