Treatment patterns, healthcare resource utilization, and costs in Medicare patients with diffuse large B-cell lymphoma: A retrospective claims analysis (2015-2020).

Abstract

AIMS To understand treatment patterns, healthcare resource utilization (HCRU), and economic burden of diffuse large B-cell lymphoma (DLBCL) in elderly adults in the US. MATERIALS AND METHODS This retrospective database analysis utilized US Centers for Medicare and Medicaid Services Medicare fee-for-service administrative claims data from 2015 to 2020 to describe DLBCL patient characteristics, treatment patterns, HCRU, and costs among patients aged ≥66 years. Patients were indexed at DLBCL diagnosis and required to have continuous enrollment from 12 months pre-index until 3 months post-index. HCRU and costs (USD 2022) are reported as per-patient per-month (PPPM) estimates. RESULTS A total of 11,893 patients received ≥1-line (L) therapy; 1633 and 391 received ≥2L and ≥3L therapy, respectively. Median (Q1, Q3) age at 1L, 2L, and 3L initiation, respectively, was 76 (71, 81), 77 (72, 82), and 77 (72, 82) years. The most common therapy was R-CHOP (70.9%) for 1L and bendamustine ± rituximab for 2L (18.7%) and 3L (17.4%). CAR T was used by 14.8% of patients in 3L. Overall, 39.6% (1L), 42.1% (2L), and 47.8% (3L) of patients had all-cause hospitalizations. All-cause mean (median [Q1-Q3]) costs PPPM during each line were $22,060 ($20,121 [$16,676-$24,597]) in 1L, $30,027 ($20,868 [$13,416-$31,016]) in 2L, and $47,064 ($25,689 [$15,555-$44,149]) in 3L, with increasing costs driven primarily by inpatient expenses. Total all-cause 3L mean (median [Q1-Q3]) costs PPPM for patients with and without CAR T were $153,847 ($100,768 [$26,534-$253,630]) and $28,466 ($23,696 [$15,466-$39,107]), respectively. CONCLUSIONS No clear standard of care exists in 3L therapy for older adults with relapsed/refractory DLBCL. The economic burden of DLBCL intensifies with each progressing line of therapy, thus underscoring the need for additional therapeutic options.