Study Examines Healthcare Use, Cost in Mantle Cell Lymphoma Treatment

A recent study noted that as the number of adverse events (AEs) increase in mantle cell lymphoma (MCL) treatment, so do the odds of hospitalization along with corresponding higher healthcare costs.

The retrospective study was based on data collected from the IQVIA Real-World Data Adjudicated Claims-US database between November 31, 2012, to January 31, 2018. Patients were over the age of 18 and had received at least 1 treatment for MCL. In total, 5049 patients were included in the study. Of those, 2509 had a drug-specific code and were classified as receiving a specific treatment regimen; 1785 of the patients had received at least 1 of the 4 most used MCL regimens: the combination of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate (Oncovin), and prednisone, known as R-CHOP; rituximab alone; bendamustine and rituximab (B‐R); and ibrutinib.

The median age was 57 years; median Charlson Comorbidity Index was 0. R‐CHOP was the most common regimen observed in the first line (26%), followed by rituximab (19%), B‐R (15%), and ibrutinib (5%).

One or more AEs were experienced by 63% of patients experienced 1 or more incident AE (R‐CHOP, 77%; B‐R, 58%; ibrutinib, 52%). An increasing number of incident AEs was associated with increased hospitalization risk (odds ratio, 2.4; 95% CI, 2.1‐2.7) and increased mean costs per patient per month (PPPM) (cost ratio = 1.1; 95% CI, 1.1‐1.2).

A higher rate of adverse effects in patients with MCL can create an economic burden for those who are commercially insured, the authors noted. The report found that treatments with more favorable toxicity profiles should be preferred. On average, those who experienced 1 or 2 adverse effects had a hospitalization and mean stay length over half less than those experiencing 3 to 5 adverse effects.

Researchers found that the largest cost contributor was medication, followed by inpatient cost. The PPPM increased from $12,584 a month in patients with 1 or 2 adverse effects to $22,052 for patients who had 3 to 5 adverse effects. For patients who were treated with common regimens, 49.7% were hospitalized at least once.

“While we did not capture less frequently used treatment regimens, this study provides insight into current MCL treatments utilized among younger, commercially insured MCL patients. The most common treatments observed were rituximab alone, R‐CHOP, B‐R, and ibrutinib,” the report stated. “This is consistent with a recent retrospective claims analysis that evaluated treatment patterns among newly diagnosed MCL patients, except that our study found a lower proportion of patients treated with B‐R, likely due to our younger study population.”

Reference

Kabadi SM, Near A, Wada K, Burudpakdee C. Treatment patterns, adverse events, healthcare resource use and costs among commercially insured patients with mantle cell lymphoma in the United States [published online October 8, 2019]. Cancer Med. doi: 10.1002/cam4.2559.