PF720 MEDICAL COSTS ASSOCIATED WITH RELAPSE AMONG PATIENTS WITH FOLLICULAR LYMPHOMA
Authors: Reddy S.R. , Chang E. , Nastoupil L. , Gokhale S. , Copher R. , Clancy Z. 
Published: June 2019

Background:

Follicular lymphoma (FL) occurs in 3.18 per 100,000 persons in the United States and is the second most common form of non‐Hodgkin lymphoma. Patients with FL have a high 5‐year survival rate (53–91%), although the disease is considered incurable and cycles of relapse and remission are common. Relapse in other lymphomas is known to be costly, e.g., a median of USD 20,000 per month for Hodgkin lymphoma; however, little is understood about the cost of relapse in FL.

Aims:

To examine the real‐world cost of relapse in patients with FL.

Methods:

Using 2007–2014 Surveillance, Epidemiology, and End Results (SEER)‐Medicare data, we identified patients diagnosed with FL (International Classification of Diseases for Oncology, 3rd edition [ICD‐O‐3] codes 9690–9691, 9695, 9698) who initiated a target first‐line (1L) treatment for FL during the identification period (January 1, 2008 to December 31, 2012). Date of diagnosis occurred on or before the first claim date for 1L treatment (index date). Patients using any drug treatment for FL before the index date were excluded. Patients were followed for ≥1 year (except due to death) until death, disenrollment, or study end. Target 1L treatments were identified by the presence of a claim for all agents (except prednisone): rituximab monotherapy (R‐mono); rituximab + bendamustine (BR); R‐CVP (rituximab, cyclophosphamide, vincristine, prednisone); R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). As physicians may modify the combination of CHOP agents, patients who were not on R‐CVP but received rituximab and ≥1 agent of cyclophosphamide, doxorubicin, and vincristine were classified as R‐CHOP‐like. Patients who initiated second‐line (2L) therapy after ≥4 cycles of index therapy and a remission period of ≥90 days (≥180 days for R‐mono) were considered to have relapsed FL. New drug therapy received before completing all cycles and achieving full remission was considered part of the previous line of therapy. The primary study endpoint was an annualized cost in 2014 USD during the first relapse period, measured from 30 days before the first relapse until a second relapse or end of follow‐up, whichever occurred first. Baseline measures included demographics and Ann Arbor staging.

Results:

2,515 patients who started targeted 1L therapy for FL and who met all selection criteria were identified. Mean age (standard deviation [SD]) was 74.1 (8.2) years, 87.2% were white, 53.8% were female, and had Ann Arbor stage III (28.4%), IV (26.8%), I (20.8%), II (17.1%), or unknown FL (6.8%). Two‐thirds of patients (66.4%) completed 1L therapy and entered remission, of whom 26.4% (n = 440) experienced a relapse and began 2L therapy. For relapsed patients, mean (SD) annual medical costs from initiation of 1L therapy to relapse were USD 59,375 (35,726), composed of outpatient non‐treatment (USD 30,031), outpatient (chemo/biologic) therapy (USD 20,896), and inpatient (USD 8,448) costs. During the relapse period (mean 2.1 years) mean (SD) annual medical costs were USD 78,301 (68,939), composed of outpatient non‐treatment (USD 37,150), outpatient treatment (USD 23,630), and inpatient (USD 17,522) costs. Among a small group of patients who experienced a second relapse (n = 57), slightly higher costs with a similar pattern were observed.

Summary/Conclusion:

The burden of annual medical costs is substantial among patients with relapsed FL, with costs rising after subsequent relapses. The largest increases in cost during the relapse period were for outpatient non‐treatment and inpatient services.