Total 1-year cost of diffuse large B-cell lymphoma (DLBCL) beyond first line (1L) therapy: A retrospective cohort analysis.

Abstract

e18333 Background: This cohort study estimated cost and healthcare use among DLBCL patients who progressed beyond 1L therapy. Methods: Using the MarketScan database, patients ≥18 years old who had R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) as 1L therapy and a claim for DLBCL (ICD-9-CM 200.7X) in the year before or 90 days after 1L start were selected for 2 cohorts: nonrelapsers who had no second line (2L) treatment for ≥2 years and 2L patients with non-R-CHOP chemotherapy after 1L. Patients not continuously enrolled for 6 months before and ≥2 years after 1L initiation, or those treated with maintenance rituximab or lenalidomide were excluded. 2L was subgrouped based on time between 1L end and 2L start: refractory (≤3 months), early (4-12 months), and late relapse (>12 months). Descriptive statistics compared cost and use between groups. Subsequent 2-year and 3-year data will be presented. Results: There were 217 (15.8%) 2L and 1,157 (84.2%) nonrelapse patients identified. Among 2L patients, 61 had hematopoietic stem cell transplant (HSCT) within 1 year. Of these HSCTs, 42.6% were early relapse patients vs. 24.6% late and 32.8% refractory (p=0.05). Mean total cost was $210,488 (SD $172,851) in 2L and $25,044 (SD $32,441) in non-relapsers (p<.001). Within 2L, mean total 1-yr cost was $232,796 in early relapse, $213,866 in late, and $191,079 in refractory (p=0.3314). For HSCT patients, cumulative 1-yr and 2-yr costs were $301,426 (Table) and $421,739. Conclusions: DLBCL treatment beyond 1L is resource intensive; chemotherapy and HSCT are major drivers of cost despite a low rate of HSCT. Cost in early relapsers may be higher than late relapsers or refractory patients due to higher transplant rates. [Table: see text]