Total costs of different lines of treatment in diffuse large B-cell lymphoma in Denmark - a real-world data analysis.

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Cure rate is high after first-line treatment, however, prognosis for relapse/refractory patients remains poor. Multiple treatments to DLBCL have recently been approved, therefore it is important to understand the underlying total costs of the different treatment lines.

Objective: To investigate the total healthcare costs per line of DLBCL treatment (first-line (1LoT), second-line (2LoT), third-line (3LoT), including best supportive care (BSC)), and to estimate patients' labour market attachment and sickness benefit level.

Method: A nationwide real-world registry study covering the Danish DLBCL patients diagnosed 2012-2021 (August) from the National Lymphoma Registry (LYFO). Data were linked with other national registries to estimate the total costs per treatment line. Additionally, costs per line were adjusted to costs per-patient-per-month (PPPM).

Results: 4,159 DLBCL patients were included. Average progression-free time before progression to next LoT or being cured decreased from 2 years (1LoT) to half a year (3LoT + BSC). Average total healthcare costs per patient were estimated to €51,660 (1LoT), €59,094 (2LoT) and €35,808 (3LoT + BSC). Adjusting for progression-free time periods, costs per PPPM increased with later treatment lines. Patients' labour market attachment was in general low, and weeks of sickness benefit increased with later treatment lines.

Conclusion: The study suggests that the total costs and weeks of sickness benefit increase with later treatment lines suggesting that more effective first-line treatment options not only have an importance for the patient prognosis but also may have an economic advantage for the healthcare sector and society.