Real-world cost of disease progression (PD) after frontline (1L) R-CHOP in diffuse large B-cell lymphoma (DLBCL): An analysis of a large US claims database.
Authors: Burke John M. , Wang Rongrong , Hossain Farah , Li Jia , Masaquel Anthony , Matasar Matthew 
Published: July 2024

e19036 Background: Previous studies on the cost of PD in DLBCL do not reflect evolving standards of care and contain limited data on novel therapies in the relapsed/refractory setting. Here, we evaluated the cost of DLBCL PD after 1L therapy using recently available data from a US healthcare database of largely commercial health plan claims. Methods: Using previously published methods (Burke, et al. 2023), this retrospective cohort study analyzed data from IQVIA PharMetrics Plus. Patients (pts) with DLBCL receiving 1L therapy with R-CHOP between October 2016 and March 2021 were included. Index date was defined as a ≥60-day gap in treatment or initiation of new agents. Pts who received non-R-CHOP therapy after 1L were assigned to the ‘PD cohort’ and those not receiving second-line (2L) treatment for ≥2 years to the ‘no PD’ cohort. All pts had continuous enrollment in medical and pharmacy benefits from R-CHOP initiation to ≥2 years post index date, allowing time for post-1L relapse. Unadjusted all-cause healthcare costs per-patient-per-month (PPPM) and 3-year cumulative costs (2023 USD) were compared between cohorts. Generalized linear models were used to adjust for baseline characteristics including age, gender, US region, payer type, Charlson Comorbidity Index (CCI), index year, and healthcare costs 1 year before index date. Results: Overall, 824 pts were included (PD cohort, n=156; no PD cohort, n=668); mean follow-up was 41.6 months. In the overall cohort: 41% were female; and at index mean (SD) age was 58.6 (11.8) years and CCI (non-cancer comorbidity) was 2.5 (3.0). Baseline characteristics were generally similar between cohorts. In the PD cohort, 76 pts (48.7%) had multiple relapse events (3L+), 67 (42.9%) received stem-cell transplant, and 27 (17.3%) received chimeric antigen T-cell therapy (CAR-T). Adjusted mean PPPM cost was higher among the PD than no PD cohort ($11,432 vs $1,698, respectively; p<0.001). A major cost driver was inpatient cost (40.1% and 21.6% of total cost for PD and no PD cohort, respectively). Treatments with CAR-T in the PD cohort were associated with an 18-fold increase in PPPM cost vs the no PD cohort ($29,794 vs $1,689, respectively; p<0.001), and a 4-fold increase vs pts with PD who did not receive CAR-T ($7,829; p<0.001). Adjusted 3-year cumulative costs were higher in the PD ($456,045) vs no PD ($60,519) cohort. Conclusions: Compared with a previous analysis on cost of PD after 1L R-CHOP in DLBCL (2010–2018; Burke, et al. 2023), this updated analysis indicates the cost is considerable, especially among pts receiving CAR-T in later lines, and is increasing, likely due to increasing utilization of novel, more expensive therapies. 1L treatments that prevent or delay relapse could thus reduce the economic burden of PD. Our findings are of use in determining the economic value of emerging 1L options that can successfully reduce the risk of relapse.