Estimating the Economic Burden of DLBCL: Developing and Testing a Cost of Disease Model
Author(s)
Michiel Zietse, PharmD1, Roelof Van Leeuwen, PharmD, PhD1, Frederick W. Thielen, BSc, MSc, PhD2, Aart Beeker, MD3.
1Erasmus University Medical Center, Rotterdam, Netherlands, 2Erasmus University Rotterdam, Rotterdam, Netherlands, 3Spaarne Gasthuis, Hoofddorp, Netherlands.
1Erasmus University Medical Center, Rotterdam, Netherlands, 2Erasmus University Rotterdam, Rotterdam, Netherlands, 3Spaarne Gasthuis, Hoofddorp, Netherlands.
OBJECTIVES: Despite the curative intent of first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemoimmunotherapy, approximately 35% of patients with diffuse large B-cell lymphoma (DLBCL) develop relapsed or refractory (r/r) disease. These patients often undergo intensive therapies including autologous or allogeneic stem cell transplantation or CAR-T cell therapy, substantially contributing to the financial burden. To quantify this, we developed and validated a cost-of-disease model to estimate the annual economic burden of DLBCL care in the Netherlands.
METHODS: A cross-sectional, population-based cost-of-relapse model was built to simulate 1,563 incident adult DLBCL patients, of whom 79% were assumed to receive active treatment. Patients could progress through up to four lines of therapy. Treatment pathways, response rates, and progression probabilities were based on clinical trials, real-world data, and patient registries. Costs included drug acquisition and hospital care, based on Dutch activity-based hospital reimbursement tariffs (diagnosis treatment combination products).
RESULTS: Technical model validation and verification were conducted externally using the AdVISHE tool, and clinical assumptions were reviewed by clinical experts. Under current practice, total costs for DLBCL care across all treatment lines were estimated at €73.7 million, corresponding to €58,670 per treated patient. The model estimated that 350 r/r DLBCL patients received treatment beyond first line (i.e., in second line or later), with mean costs of €147,936 per patient, driven primarily by the use of CAR-T cell therapy. Second-line therapy accounted for the largest share of total expenditures (€23.6 million).
CONCLUSIONS: This model quantifies the economic impact of DLBCL in the Netherlands and highlights the disproportionate burden of r/r DLBCL. It can support the evaluation of novel therapies, inform reimbursement decisions, guide resource allocation, identify priorities for future research, and indicate where the financial burden is highest along the care pathway. Future model iterations could incorporate novel therapies, adverse-event and societal costs, healthcare capacity, and environmental metrics.
METHODS: A cross-sectional, population-based cost-of-relapse model was built to simulate 1,563 incident adult DLBCL patients, of whom 79% were assumed to receive active treatment. Patients could progress through up to four lines of therapy. Treatment pathways, response rates, and progression probabilities were based on clinical trials, real-world data, and patient registries. Costs included drug acquisition and hospital care, based on Dutch activity-based hospital reimbursement tariffs (diagnosis treatment combination products).
RESULTS: Technical model validation and verification were conducted externally using the AdVISHE tool, and clinical assumptions were reviewed by clinical experts. Under current practice, total costs for DLBCL care across all treatment lines were estimated at €73.7 million, corresponding to €58,670 per treated patient. The model estimated that 350 r/r DLBCL patients received treatment beyond first line (i.e., in second line or later), with mean costs of €147,936 per patient, driven primarily by the use of CAR-T cell therapy. Second-line therapy accounted for the largest share of total expenditures (€23.6 million).
CONCLUSIONS: This model quantifies the economic impact of DLBCL in the Netherlands and highlights the disproportionate burden of r/r DLBCL. It can support the evaluation of novel therapies, inform reimbursement decisions, guide resource allocation, identify priorities for future research, and indicate where the financial burden is highest along the care pathway. Future model iterations could incorporate novel therapies, adverse-event and societal costs, healthcare capacity, and environmental metrics.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE426
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology