OBJECTIVES : R/R-MCL is an incurable, aggressive B-cell lymphoma as most patients will relapse. While costs are unknown, median overall survival for salvage regimens post-ibrutinib is 5.8 months (Martin et al. 2016). We describe costs and HRU patterns for patients who fail ibrutinib.

METHODS : Using IQVIA claims, this analysis describes R/R-MCL patients failing prior chemotherapy, rituximab, and ibrutinib (using multi-step algorithm) between November 13, 2013 and August 31, 2017. Primary outcomes were treatment patterns, site-of-care costs and total cost pre/post-ibrutinib failure. Demographic, treatment patterns, and costs were analyzed descriptively. Median follow-up analyzed by Kaplan-Meier method.

RESULTS : For the 64 R/R-MCL patients identified, median age was 63 (range 49-84) years and 72% were male. Pre-ibrutinib, patients received a median of 2 (range 1-5) regimens, including bendamustine (72%), R-CHOP (52%), and bortezomib (25%) with 22% receiving hematopoietic stem cell transplant (HSCT). Post-ibrutinib failure, 41% patients continued with salvage therapies and <1% received HSCT. Post-ibrutinib, a median of 2 (range 1-5) regimens were administered--including lenalidomide (35%), bortezomib (25%), and bendamustine (23%). Median per-patient-per-month healthcare costs pre-ibrutinib, during ibrutinib, and post ibrutinib treatment were $21,728 (range $1,730 - $78,631), $21,664 (range $6,335 - $505,675), and $24,103 (range $0 - $554,440), respectively. Drug costs were a major driver of healthcare costs pre- and during ibrutinib treatment, representing 46% and 73% of total costs, respectively. However, post-ibrutinib, hospital costs represented the greatest share (54%) of total costs. There was a trend in longer follow-up time in the group receiving subsequent therapies (p=0.06).

CONCLUSIONS : There is no standard of care for R/R-MCL patients who fail ibrutinib. Most patients (59%) did not receive any subsequent therapy post-ibrutinib, demonstrating an unmet need for novel therapies. Those who did received less intensive, single-agent therapies. The healthcare costs for such patients remain high with inpatient costs being the largest contributor.