Economic Burden and Patterns of Care Among Patients with Follicular Lymphoma in the US: A Retrospective Claims Analysis
Authors: Garg Mahek , Satija Ambika , Song Yan , Meade Ben , Signorovitch James , Gandra Shravanthi 
Published: December 2024

Background: Follicular lymphoma (FL) is the most common indolent non-Hodgkin's lymphoma with an evolving treatment landscape.
Objective: To describe real-world healthcare resource use (HRU), costs, and treatment patterns among FL patients in the US.
Methods: This retrospective cohort study was conducted using Optum's de-identified Clinformatics® Data Mart Database from October 1, 2015 to March 31, 2021. Newly diagnosed FL patients as identified by ≥2 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes for FL (C82.xx) comprised the study sample. The date of first FL diagnosis was defined as the index date. Patients were included if aged 18 years or older, were continuously enrolled for ≥12 months pre- and ≥1-month post-index, and had no evidence of any malignancies (including FL) before the index date. The study outcomes included all-cause and FL-related HRU estimated as monthly incidence rates and costs estimated per-patient-per month (PPPM). For the treatment pattern analysis, a line of therapy (LOT) algorithm was applied to a subsample with no claims for treatments of interest prior to index date and ≥1 claim for treatments in the study period. LOTs of systemic therapies, stem cell transplant, and chimeric antigen receptor (CAR) T-cell therapies were identified. HRU and costs were described in the first line (1L), second line (2L), and third and subsequent line (3L+) periods for the treated subsample.
Results: A total of 2,805 eligible patients were followed for a mean of 25 months, with a mean age of 68 (±13) years, 52% female, and 68% insured by Medicare Advantage. The most common baseline comorbidities were cardiovascular disease and diabetes (both 26%). Patients had 2.48 all-cause outpatient (OP), 0.07 inpatient (IP), and 0.05 emergency room (ER) visits per month on average. Less than half of visits in each category were FL-related. Ninety-seven percent of all-cause total costs ($12,402 PPPM) were due to medical services ($12,060), driven equally by IP ($5,837) and OP ($5,820) costs. FL-related medical costs accounted for over half of all-cause costs ($8,291). The treatment pattern analysis included 1,095 patients, of whom 22% received 2+ LOTs. Bendamustine-based therapies and rituximab monotherapy were the most common regimens across lines (41% and 26% in 1L, 14% and 47% in 2L, and 13% and 51% in the third line, respectively). All-cause and FL-related HRU and costs generally increased with LOTs. For example, monthly all-cause IP visits increased from 0.06 visits in 1L to 0.09 visits in 3L+. Similarly, FL-related IP costs more than doubled from 1L ($3,014) to 3L+ ($7,344), constituting larger portions of total FL-related medical costs (1L: 27%; 3L+: 62%).
Conclusions: This study describes the current treatment landscape of FL in the US, highlighting bendamustine-based therapies and rituximab monotherapy as the most commonly used, and characterizes high economic burden which increases with each LOT.