PCN88 Systematic Literature Review (SLR) of Economic and Healthcare Resource Utilization Evidence in the Treatment of Relapsed or Refractory Large B-Cell Lymphoma (LBCL)

Abstract

To conduct an SLR to understand the breadth of economic and healthcare resource utilization evidence for relapsed/refractory LBCL. We searched MEDLINE, Embase, NHS Economic Evaluation Database, Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination Health Technology Appraisals database, Tufts Cost-Effectiveness Analysis Registry, and Health Economics Research Centre Database of Mapping Studies from 1/2003–6/2020. English-language articles, conference abstracts, and health technology assessments (HTAs) reporting costs for treatment of relapsed/refractory LBCL were included. Of 6791 records screened, 46 were included. Forty-two unique economic studies (costing studies [n=24]; cost-effectiveness analyses [n=9]; HTAs [n=9]) were identified (US [n=24], UK [n=5], Canada [n=4], Australia [n=2], Malawi [n=2], Spain [n=2], Chile [n=1], France [n=1], France/UK [n=1]). In the US (n=4), first-year total healthcare costs were $159,729–$182,516 for chemotherapy and $282,022–$455,741 for stem cell transplantation (SCT) and chemotherapy; highest costs were attributed to allogeneic SCT (allo-SCT) with chemotherapy. In France (n=1), mean per-patient hospital costs were €93,233 for index allo-SCT, €14,617 for pre-allo-SCT chemotherapy, and €16,625 for 6-month post-allo-SCT follow-up care. Mean length of stay (LOS) and associated inpatient costs varied by treatment in the US (SCT: 24.6–32.3 days, $123,455–$248,390; chemotherapy: 5.9–12.9 days, $55,068–$75,094; CAR T-cell therapy: 14.3–23.3 days, $376,982–$429,415). CAR T-cell therapy costs (excluding CAR T acquisition cost) from leukapheresis to 2 months post-infusion were higher in the US ($64,784) versus France (€30,172) and the UK (£24,009). Cross-study reporting was highly variable, with definitions, cost components, and follow-up inconsistently reported. Despite this variation, SCT, particularly allo-SCT, incurred higher first-year costs than salvage chemotherapy. Inpatient costs were greater for CAR T-cell therapy than SCT and chemotherapy. Mean LOS for SCT was 1–18 and 12–26 days longer than CAR T-cell therapy and chemotherapy, respectively. Reporting consistency should be considered when interpreting cross-study results.