REAL-WORLD TREATMENT PATTERNS AND CAR-T THERAPY UTILIZATION AMONG MEDICARE BENEFICIARIES WITH DIFFUSE LARGE B-CELL LYMPHOMA
Author(s)
Salome Ricci, PharmD, PhD1, Alison Duffy, PharmD1, Eberechukwu Onukwugha, MSc, PhD1, Juan-David Rueda, MS, PhD, MD2, Jean A. Yared, MD3, Julia F. Slejko, PhD1.
1Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore, Baltimore, MD, USA, 2AstraZeneca, Gaithersburg, MD, USA, 3University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
1Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore, Baltimore, MD, USA, 2AstraZeneca, Gaithersburg, MD, USA, 3University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
OBJECTIVES: Chimeric antigen receptor T-cell (CAR-T) therapy has transformed treatment for relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL), but real-world utilization and the characteristics of who receives it remain sparsely described in a contemporary Medicare population in the United States. We characterized treatment patterns across lines of therapy and the profile of CAR-T recipients among Medicare fee-for-service (FFS) beneficiaries with incident DLBCL.
METHODS: Using a 20% sample of Chronic Conditions Warehouse Medicare FFS claims (2017-2023), we identified incident DLBCL beneficiaries and characterized regimen distribution from first (1L) through fourth line (4L), patient characteristics by line and by CAR-T receipt status, and temporal trends by era of diagnosis (early, 2017-2020; late, 2021-2023). Lines of therapy were assigned using a longitudinal rules-based claims algorithm. Descriptive statistics were compared using chi-square and Mann-Whitney U tests.
RESULTS: Among 10,179 beneficiaries, 63.9% initiated systemic therapy; untreated patients were older, more comorbid, and more often Medicare-Medicaid dual-eligible or low-income-subsidy (LIS) recipients. Approximately 25% of treated patients reached 2L+. 1L was predominantly CHOP-based; later lines were heterogeneous with no dominant regimen. Among 1,589 relapsed/refractory (2L+) patients, 13.2% received CAR-T therapy at any line. CAR-T therapy recipients were younger (mean 72.7 vs. 76.2 years; p<0.001), less comorbid (adjusted Quan-CCI 0.5 vs. 0.8; p=0.003), and less socioeconomically disadvantaged (LIS 5.7% vs. 12.5%, p=0.004; dual eligible <6% vs. 10.5%, p=0.005) than non-recipients. Between eras, CAR-T therapy expanded in 2L and 3L; and novel/targeted agents uptake grew across all lines.
CONCLUSIONS: In a contemporary Medicare cohort, CAR-T uptake among R/R DLBCL patients remained limited. Recipients were systematically younger, healthier, and less socioeconomically disadvantaged than non-recipients. These findings motivate further investigation into the clinical and structural determinants of CAR-T receipt.
METHODS: Using a 20% sample of Chronic Conditions Warehouse Medicare FFS claims (2017-2023), we identified incident DLBCL beneficiaries and characterized regimen distribution from first (1L) through fourth line (4L), patient characteristics by line and by CAR-T receipt status, and temporal trends by era of diagnosis (early, 2017-2020; late, 2021-2023). Lines of therapy were assigned using a longitudinal rules-based claims algorithm. Descriptive statistics were compared using chi-square and Mann-Whitney U tests.
RESULTS: Among 10,179 beneficiaries, 63.9% initiated systemic therapy; untreated patients were older, more comorbid, and more often Medicare-Medicaid dual-eligible or low-income-subsidy (LIS) recipients. Approximately 25% of treated patients reached 2L+. 1L was predominantly CHOP-based; later lines were heterogeneous with no dominant regimen. Among 1,589 relapsed/refractory (2L+) patients, 13.2% received CAR-T therapy at any line. CAR-T therapy recipients were younger (mean 72.7 vs. 76.2 years; p<0.001), less comorbid (adjusted Quan-CCI 0.5 vs. 0.8; p=0.003), and less socioeconomically disadvantaged (LIS 5.7% vs. 12.5%, p=0.004; dual eligible <6% vs. 10.5%, p=0.005) than non-recipients. Between eras, CAR-T therapy expanded in 2L and 3L; and novel/targeted agents uptake grew across all lines.
CONCLUSIONS: In a contemporary Medicare cohort, CAR-T uptake among R/R DLBCL patients remained limited. Recipients were systematically younger, healthier, and less socioeconomically disadvantaged than non-recipients. These findings motivate further investigation into the clinical and structural determinants of CAR-T receipt.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD133
Topic
Health Service Delivery & Process of Care, Real World Data & Information Systems, Study Approaches
Topic Subcategory
Health & Insurance Records Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology