Health Care Resource Use in the Management of Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma in Canada

OBJECTIVES: In October 2023, epcoritamab was the first subcutaneous bispecific drug approved by Health Canada for relapsed/refractory diffuse large B-cell lymphoma (R/R-DLBCL), after two or more lines of systemic therapy and in patients who have previously received or are unable to receive CAR-T cell therapy and are transplant ineligible. Currently, no published Canadian health care resource utilization (HCRU) studies in R/R-DLBCL exist to assess HCRU of epcoritamab versus novel therapies. This study aimed to estimate HCRU costs of R/R-DLBCL treatments, to inform health technology assessment agencies, institutional decision makers and healthcare professionals from a Canadian perspective. Secondary objectives included using a societal perspective and estimating chair time and personnel time involved in administering treatments.

METHODS: A costing analysis was developed from a Canadian perspective, comparing epcoritamab to other R/R DLBCL treatments, glofitamab, CAR-T cell therapies, chemotherapy and polatuzumab vedotin + bendamustine + rituximab. Costs related to pretreatment, administration, monitoring, and adverse event (AE) management were included and multiple time horizons were assessed. Acquisition costs of active treatments were excluded. Model inputs were from product labels and were validated by Canadian clinical experts to reflect practice.

RESULTS: Total HCRU costs over one-year ranged from $11,009 to $54,946. Epcoritamab ranked as the second least costly comparator at $13,526 with notable HCRU costs savings driven by low administration and AE management costs. Epcoritamab still ranked similarly from a societal perspective and over a 2-year time-horizon scenario. Epcoritamab had the lowest annual chair time of 810 minutes amongst comparators. For every 100 hypothetical patients treated with epcoritamab, epcoritamab could potentially free up capacity to treat between 90 and 483 more patients.

CONCLUSIONS: In the context of a highly constrained Canadian healthcare system, epcoritamab offers substantial HCRU-related cost savings and valuable time savings, making it an attractive, patient-centric treatment option for R/R-DLBCL.