1
|
Acheampong T, Gu T, Le TK, Keating SJ. Treatment patterns and costs among US patients with diffuse large B-cell lymphoma not treated with 2L stem cell transplantation. Future Oncol 2024; 20:623-634. [PMID: 38230990 DOI: 10.2217/fon-2023-0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Aim: To assess treatment patterns, healthcare resource utilization (HCRU), and costs for patients with diffuse large B-cell lymphoma (DLBCL) who did not receive stem cell transplantation in second-line. Patients & methods: An administrative MarketScan® database study to assess DLBCL claims from 01/01/2009-30/09/2020. Results: Most patients (n = 750) received rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone in first-line (86.8%) and rituximab (39.5%) or bendamustine ± rituximab ± other (16.3%) in second-line. Over half were hospitalized (mean duration: 16.5 (standard deviation [SD]: 25.8) days per patient per year). Mean medical/pharmacy costs were US$141,532 per patient per year (SD: $189,579), driven by DLBCL-related claims. Conclusion: Healthcare resource utilization and costs for DLBCL-related claims were due to hospitalizations and outpatient visits. Novel therapies to reduce clinical and economic burdens are needed.
Collapse
Affiliation(s)
| | - Tao Gu
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA
| | - Trong Kim Le
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA
| | - Scott J Keating
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA
| |
Collapse
|
2
|
Bouttell J, Fraser H, Goodlad JR, Hopkins D, McKay P, Oien KA, Seligmann B, von Delft S, Hawkins N. Adding a Gene Expression Profile Test to Aid Differential Diagnosis and Treatment in Aggressive Large B-Cell Lymphoma: An Early Exploratory Economic Evaluation. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:243-254. [PMID: 38017318 DOI: 10.1007/s40258-023-00845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Adding gene expression profiles (GEPs) to the current diagnostic work-up of aggressive large B-cell lymphomas may lead to the reclassification of patients, treatment changes and improved outcomes. A GEP test is in development using TempO-Seq® technology to distinguish Burkitt lymphoma (BL) and primary mediastinal large B-cell lymphoma (PMBCL) from diffuse large B-cell lymphoma (DLBCL), and to classify patients with DLBLC and to predict the benefit of (e.g.) adding bortezomib to R-CHOP therapy (RB-CHOP). This study aims to estimate the potential impact of a GEP test on costs and health outcomes to inform pricing and evidence generation strategies. METHODS Three decision models were developed comparing diagnostic strategies with and without GEP signatures over a lifetime horizon using a UK health and social care perspective. Inputs were taken from a recent clinical trial, literature and expert opinion. We estimated the maximum price of the test using a threshold of Great Britain Pound (GBP) 30,000 per quality-adjusted life-year (QALY). Sensitivity analyses were conducted. RESULTS The estimated maximum threshold price for a combined test to be cost effective is GBP 15,352. At base-case values, the BL signature delivers QALY gains of 0.054 at an additional cost of GBP 275. This results in a net monetary benefit at a threshold of GBP 30,000 per QALY of GBP 1345. For PMBCL, the QALY gain was 0.0011 at a cost saving of GBP 406 and the net monetary benefit was GBP 437. The hazard ratio for the impact of treating BL less intensively must be at least 1.2 for a positive net monetary benefit. For identifying patients with the DLBCL subtype responsive to bortezomib, QALY gain was 0.2465 at a cost saving of GBP 6175, resulting in a net monetary benefit of GBP 13,570. In a probabilistic sensitivity analysis using 1000 simulations, a testing strategy was superior to a treat all with R-CHOP strategy in 81% of the simulations and with a cost saving in 92% assuming a cost price of zero. CONCLUSIONS Our estimates show that the combined test has a high probability of being cost effective. There is good quality evidence for the benefit of subtyping DLBCL but the evidence on the number of patients reclassified to or from BL and PMBCL and the impact of a more precise diagnosis and the cost of treatment is weak. The developers can use the price estimate to inform a return on investment calculations. Evidence will be required of how well the TempO-Seq® technology performs compared to the testing GEP technology used for subtyping in the recent clinical trial. For BL and PMBCL elements of the test, evidence would be required of the number of patients reclassified and improved costing information would be useful. The diagnostic and therapeutic environment in haematological malignancies is fast moving, which increases the risk for developers of diagnostic tests.
Collapse
Affiliation(s)
- Janet Bouttell
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Health Economics and Health Technology Assessment, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK.
| | - Heather Fraser
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John R Goodlad
- NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, UK
| | - David Hopkins
- NHS Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, UK
| | - Pam McKay
- NHS Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, UK
| | - Karin A Oien
- School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Stephan von Delft
- Adam Smith Business School, University of Glasgow, Glasgow, UK
- Reach Euregio Start-up Center, University of Münster, Münster, Germany
| | - Neil Hawkins
- Health Economics and Health Technology Assessment, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK
| |
Collapse
|
3
|
Pennings ERA, Durmaz M, Visser O, Posthuma EFM, Issa DE, Chamuleau MED, Lugtenburg PJ, Kersten MJ, Dinmohamed AG. Treatment and outcomes for patients with relapsed or refractory diffuse large B-cell lymphoma: a contemporary, nationwide, population-based study in the Netherlands. Blood Cancer J 2024; 14:3. [PMID: 38177115 PMCID: PMC10766619 DOI: 10.1038/s41408-023-00970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Elise R A Pennings
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Müjde Durmaz
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Eduardus F M Posthuma
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Djamila E Issa
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Martine E D Chamuleau
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieternella J Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
- Department of Hematology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
4
|
Borchmann P, Heger JM, Mahlich J, Papadimitrious MS, Riou S, Werner B. Survival outcomes of patients newly diagnosed with diffuse large B-cell lymphoma: real-world evidence from a German claims database. J Cancer Res Clin Oncol 2023; 149:7091-7101. [PMID: 36871091 DOI: 10.1007/s00432-023-04660-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma with increasing incidence. Although the burden of disease is high, only limited current real-world data on survival analysis, especially survival time, of German patients with DLBCL are available. This retrospective claims-based analysis was conducted to describe real-world survival evidence and treatment patterns of patients with DLBCL in Germany. METHODS Using a large claims database of the German statutory health insurance with 6.7 million enrollees, we identified patients between 2010 and 2019 who were newly diagnosed with DLBCL (index date) and had no other cancer co-morbidity. Overall survival (OS) from index date and from the end of each treatment line was plotted by means of the Kaplan-Meier estimator, both for the overall cohort and stratified by treatment regimen. Treatment lines were identified based on a predefined set of medications categorized by established DLBCL treatment recommendations. RESULTS 2495 incident DLBCL patients were eligible for the study. After index date, 1991 patients started a first-line, 868 a second-line, and 354 a third-line therapy. In first line, 79.5% of patients received a Rituximab-based therapy. 5.0% of the of the 2495 patients received a stem cell transplantation. Overall, median OS after index was 96.0 months. CONCLUSION DLBCL-associated mortality is still high, especially in relapsed patients and in the elderly. Therefore, there is a high medical need for new effective treatments that can improve survival outcomes in DLBCL patients.
Collapse
Affiliation(s)
- Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Jan-Michel Heger
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Jörg Mahlich
- Miltenyi Biomedicine, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany.
- DICE-Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | | | - Sybille Riou
- Miltenyi Biomedicine, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany
| | - Barbara Werner
- Team Gesundheit Gesellschaft für Gesundheitsmanagement mbH, Rellinghauser Str. 93, 45128, Essen, Germany
| |
Collapse
|
5
|
Borchmann P, Heger JM, Mahlich J, Papadimitrious MS, Riou S, Werner B. Healthcare Resource Utilization and Associated Costs of German Patients with Diffuse Large B-Cell Lymphoma: A Retrospective Health Claims Data Analysis. Oncol Ther 2023; 11:65-81. [PMID: 36447041 PMCID: PMC9935789 DOI: 10.1007/s40487-022-00211-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin's lymphoma with increasing prevalence. Although the disease burden associated with DLBCL is high, only limited data on healthcare resource utilization (HCRU) and associated costs of German patients with DLBCL is available. METHODS Using a large claims database of the German statutory health insurance with 6.7 million enrollees, we identified patients who were newly diagnosed with DLBCL between 2011 and 2018 (index date). Treatment lines were identified based on a predefined set of medication. HCRU and related costs were collected for the entire post index period and per treatment line. RESULTS A total of 2495 incident DLBCL patients were eligible for the analysis. The average follow-up time after index was 41.7 months. During follow-up, 1991 patients started a first-line treatment, 868 a second-line treatment, and 354 a third-line treatment. Overall, patients spent on average (SD) 5.24 (6.17) days per month in hospital after index. While on anti-cancer treatment, this number increased to nine (10.9) in first-line, 8.7 (13.7) in second-line, and 9.4 (15.8) in third-line treatments. Overall costs per patient per month (PPPM) increased from €421 (875.70) before to €3695 (4652) after index. While on a treatment line, PPPM costs were €17,170 (10,246) in first-line, €13,362 (12,685) in second-line, and €12,112 (16,173) in third-line treatments. Time-unadjusted absolute costs sum up to €59,868 (43,331), €35,870 (37,387), and €28,832 (40,540) during first-line, second-line, and third-line treatments, respectively. The main cost drivers were hospitalizations (71% of total costs) and drug acquisition costs (18% of total costs). CONCLUSIONS The financial burden of DLBCL in Germany is high, mainly due to hospitalization and drug costs. Therefore, there is a high medical need for new cost-effective therapeutic options that can lower the disease burden and remain financially viable to support the growing number of patients with this aggressive disease.
Collapse
Affiliation(s)
- Peter Borchmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Kerpener Str. 60, 50937, Cologne, Germany
| | - Jan-Michel Heger
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Kerpener Str. 60, 50937, Cologne, Germany
| | - Jörg Mahlich
- Miltenyi Biomedicine, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany.
- DICE, Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | | | - Sybille Riou
- Miltenyi Biomedicine, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany
| | - Barbara Werner
- Team Gesundheit GmbH, Rellinghauser Str. 93, 45128, Essen, Germany
| |
Collapse
|