Comparison of Out-of-Pocket Costs and Quality of Life (QOL) for Patients (pts) with Hodgkin’s Disease (HD), Indolent Non-Hodgkin’s Lymphoma (INHL) and Aggressive Non-Hodgkin’s Lymphoma (ANHL).
Authors: Nonzee Narissa J. , Brown Sheila O. , Chang Chih-Hung , Evens Andrew M. , Gordon Leo I. , Winter Jane N. , Bowman Lee , Kutikova Lucie , Bennett Charles L. 
Published: October 2019

Abstract
BACKGROUND: We report preliminary results from a study on the out-of-pocket costs (cancer related costs not covered by healthcare insurance) for 57 lymphoma pts. To explore factors that influence out-of-pocket costs and QOL, cancer type, stage, time since diagnosis (Dx), treatment type (with or without rituximab), and age were evaluated.
METHODS: Lymphoma pts provided information on out-of-pocket costs for 3-month periods after lymphoma Dx and completed the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) QOL measure. Monthly costs were evaluated. Direct medical costs are costs related to medications, hospital bills, and doctor visits. Direct non-medical costs are peripheral costs related to transportation, meals, and telephone calls.
RESULTS: The majority of lymphoma pts were Caucasian (87%), married (63%), ≤ 55 years old (58%), and employed (40%). All pts were undergoing active treatment and had healthcare insurance coverage. 62% of pts had stage I-III lymphoma, 35% had stage IV, and 3% had unknown stage. Mean monthly total out-of-pocket costs for all 57 lymphoma pts were $818. Direct medical costs for HD pts were 3.2 and 1.4-fold higher than for INHL and ANHL pts, respectively. Direct non-medical costs were highest for ANHL. Total costs for pts < 6 months since Dx were 1.5 and 2.2-fold higher than for pts 6–12 and > 12 months since Dx, respectively. Total costs for pts undergoing treatment without rituximab were 1.5-fold higher than costs for pts with rituximab. Pts ≤ 55 years old had 1.4-fold higher costs than pts > 55 years old. QOL for pts < 6 months since Dx was greater than for pts ≥ 6 months since Dx (p-value =0.02).
CONCLUSION: The mean monthly out-of-pocket costs were greatest for HD ($1,136), followed by ANHL ($847) and INHL ($447), and were driven primarily by direct medical costs. Though pts < 6 months since Dx incurred higher total costs than pts ≥ 6 months since Dx, their QOL measures were better. It is important to evaluate costs and quality of life of pts with cancer when describing the economic and psychosocial burden of cancer.
Direct Medical, Direct Non-medical, and Total (Medical & Non-medical) Mean Out-of-Pocket Cost per Month N Direct Medical Out-of-Pocket Cost ($/month) Direct Non-medical Out-of-Pocket Cost ($/month) Total Out-of-Pocket Cost ($/month) All Patients 57 647 171 818 Cancer Type Hodgkin’s Lymphoma 16 972 164 1,136 Aggressive NHL 24 671 176 847 Indolent NHL 17 307 170 477 Time since diagnosis <6 months 28 893 165 1,058 6–12 months 13 494 215 709 >12 months 16 341 146 487 Treatment Type With Rituximab 36 543 143 686 Without Rituximab 21 825 219 1,044 Age <=55 yrs old 33 734 188 923 >55 yrs old 24 527 146 673 Quality of Life of Lymphoma Patients N FACT-Lymphoma Score p-value All Patients 60 126 Cancer Type 0.65 Hodgkin’s Lymphoma 17 126 Aggressive NHL 25 128 Indolent NHL 18 121 Cancer Stage 0.37 I–III 37 124 IV 21 126 N/R 2 149 Time since diagnosis 0.02 <6 months 29 134 6–12 months 15 116 >12 months 16 118 Age 0.28 <=55 yrs old 35 122 >55 yrs old 25 129