Impact of Disease Progression On Healthcare Cost and Resource Utilization Among Follicular NHL Patients Treated within the US Oncology Network.
Authors: Gruschkus Stephen K , Darragh Joseph M , Kolodziej Michael A , Beveridge Roy A , Forsyth Michael , Reyes Carolina 
Published: October 2019

Abstract
Abstract 4543
Follicular non-Hodgkin's Lymphoma (f-NHL) is a common type of b-cell lymphoma, accounting for approximately 30% of all NHL cases and 70% of indolent lymphomas. The purpose of this project was to estimate the economic cost of progression for patients with f-NHL treated in the outpatient community setting.
Using US Oncology's iKnowMed electronic medical record (EMR) system, we identified and characterized f-NHL patients who received care within the US Oncology network between July 1, 2006 and February 29, 2008. It is estimated that the NHL patients with documented care in iKnowMed represent approximately 5-6 % of all newly diagnosed NHL patients in the United States. Patients were divided into two cohorts depending on whether they experienced disease progression during the study catchment period. Patients were then characterized with respect to relevant demographic and clinical characteristics and were followed over a 6 month period. Costs were estimated based on outpatient claims and were normalized to unadjusted 2007 Medicare reimbursement rates. To estimate the incremental cost of progression, costs per patient-month were compared between patients who did and did not experience disease progression. Multiple regression modeling techniques were employed to describe the impact of progression on healthcare cost after adjusting for potential confounders. Finally, to further explore the economic burden of disease progression, we compared resource utilization as measured by frequency of outpatient physician visits, chemotherapy infusion visits, laboratory procedures, and acute care visits.
A total of 1,002 f-NHL patients were identified- 204 patients experienced disease progression and 798 did not. Patients who progressed were more likely to have been diagnosed with advanced stage disease and with 4+ positive lymph nodes and also tended to have a worse performance status and less favorable lab values (elevated LDH and low Hgb) at the study index date. Overall crude costs were significantly higher for patients following disease progression compared to patients without progression (difference = $2,647 per patient-month; p<0.001). Patients who progressed have significantly higher costs for outpatient visits, chemotherapy infusions, other medications, laboratory procedures and minor procedures. In a multivariable regression model controlling for significant clinical factors such as performance status, hemoglobin level, and number of positive lymph nodes, disease progression remained significantly associated with a greater than 200% increase in total cost. When we compared frequency of billed services by progression status, we found that patients with disease progression had significantly higher frequencies of outpatient physician visits and laboratory procedures compared to patients without progression and were more likely to receive intensive chemotherapy regimens and to be admitted to the hospital and/or ER.
Using linked EMR and claims data, this retrospective study highlights and quantifies the economic costs of progression among patients with f-NHL treated within the outpatient community-based setting. Results of this study suggest that efforts to delay disease progression may provide substantial economic benefits in addition to the previously demonstrated improvements in clinical outcomes and patient quality of life.
Table 1. Outpatient Costs by Progression Status Cost CP - CNP* No Progression (NP) (n=798) Progression (P) (n=204) Cumulative Cost US$ US$ US$     Month 1 2,122 5,961 3,839     Month 2 2,883 10,610 7,727     Month 3 3,553 14,566 11,013     Month 4 4,219 17,459 13,240     Month 5 4,695 19,482 14,787     Month 6 5,165 21,496 16,331 Cost per Patient- Month US$ US$ US$     Total 965 3,612 2,647     Outpatient visits 40 102 62     Chemotherapy** 732 2,554 1,822     Other medication 108 715 607     Labs 12 29 17     Minor Procedures 3 10 7 * p<0.001 for all cost differences; ** Includes immunotherapy

Disclosures:
Reyes: Genentech Inc: Employment, Equity Ownership.