OBJECTIVES

To evaluate treatment patterns and treatment cost among patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL).

METHODS

Using a third-party administrative claims database we identified patients with a diagnosis of DLBCL (at least one inpatient/emergency department or ≥2 outpatient claims for lymphoma) between 01/01/2014-06/01/2018, at least one-month pre- and 6-months post-diagnosis continuous enrollment and treated with at least two lines of therapy. Patients with a record of allogenic stem cell transplant or another cancer diagnosis were excluded. Healthcare costs were assessed following initiation of second-line therapy through discontinuation of second-line therapy. Treatments were categorized as rituximab-based or non-rituximab-based, the latter was further categorized as targeted/novel agents or chemotherapies. Treatment costs were compared between patients on the three categories of second-line therapy. Duration of therapy was estimated between second-line initiation and second-line discontinuation.

RESULTS

936 DLBCL patients initiated second-line therapy (median age 65y; 43.7% female; 47.2% commercially insured; mean Charlson Comorbidity Score 3.75 (SD: 1.56)). Adjusted mean treatment cost through end of second-line was $25,620 (SD: $62,096) per person per month (PPPM). Of all second-line therapies, 62.3% were rituximab-based, 16.7% non-rituximab targeted/novel agents, and 20.5% were non-rituximab chemotherapy. There were significant differences in mean cost PPPM between rituximab-based therapies ($16,975, SD: $104,570), non-rituximab targeted/novel therapies ($80,736, SD: $229,270), and non-rituximab chemotherapies ($12,262, SD: $43,174) (p < 0.001). The median duration of second-line therapy was 3.67 months, longest among patients with rituximab-based therapy (4.08 months) followed by non-rituximab targeted/novel therapies (3.25 months) and non-rituximab chemotherapies (2.42 months).

CONCLUSIONS

Costs of second-line DLBCL treatment are higher for non-rituximab targeted/novel therapies compared to the non-rituximab chemotherapies and rituximab-based therapies. Rituximab-based treatment remains the most common and has the longest duration of therapy.