Cost of follicular lymphoma (FL) in Medicare patients

Abstract

6634 Background: Over 10,000 cases of FL were diagnosed in 2007 in the United States. The direct medical costs attributable to FL are not clearly documented. Methods: We analyzed the cost of FL using SEER-Medicare data. Patients had FL (by histology) as their first primary cancer diagnosed between 1998–2002 with follow up through 2005. Patients had to have > 1 year of prior non-HMO Medicare coverage. Costs were taken from claims for inpatient, outpatient and physician services. Control comparisons were made both to the pre-diagnosis 12 month period and to a 5% sample of Medicare patients without a cancer diagnosis. Chemoimmunotherapy (CT) was classified based on agents used after diagnosis. Linear regression models were adjusted for age, co-morbidity score, diagnosis year, gender, and county of residence. Results: There were 2,053 patients who met the inclusion criteria. The median time from diagnosis to first CT was 159 days. The most common CT regimens included CHOP±R (32%) and rituximab alone (25%) and CVP±R (18%). The unadjusted mean monthly cost was similar compared to both control groups (>$3,000). This cost declined over time but did not reach the pre-diagnosis level. After adjustment the incremental cost of FL was $3,202/month for the first year compared to the 5% Medicare sample (p<0.05). Increasing age, male gender, and Black race were significantly associated with increased monthly costs (p<0.05). Conclusions: FL is associated with increased costs of care in the Medicare population, particularly in the first year after diagnosis where it is over $36,000 per patient. Mean monthly cost ($) relative to diagnosis date Health Service 12 Months Before 12 Months After 12–24 Months After 24–36 Months After Medicare 5% Sample Inpatient facility 230 2030 799 792 227 Provider 167 1507 732 1024 134 Outpatient facility 16 35 22 29 5 Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Genentech Genentech Genentech