OBJECTIVES: Diffuse large B-cell lymphoma (DLBCL) and B-cell acute lymphoblastic leukemia (B-ALL) are aggressive cancers associated with significant morbidity and costs. Understanding the lifetime direct and indirect economic burdens of these conditions is essential to projecting incremental savings of curative therapies. This study reviews the current literature with the goal of informing potential financial impact to the US healthcare system.

METHODS: We conducted a literature review of PubMed (MEDLINE and PMC databases) and the Tufts CEA Registry to identify English language studies published within the last ten years (2009 to 2018) relating to lifetime costs of treatment for DLBCL or B-ALL in the United States. Publications of interest included primary studies or reviews reporting direct or indirect lifetime healthcare costs for treated patients. Primary exclusion criteria included studies: reporting non-US costs, not in English, or using non-lifetime horizons. We report all costs in 2017 US dollars.

RESULTS: Of 172 initial peer-reviewed studies, seven satisfied all inclusion/exclusion criteria (DLBCL n=3, B-ALL n=4). These studies yielded 17 lifetime cost estimates across various treatment regimens for DLBCL (standard chemotherapy, rituximab, lenalidomide, ASCT, plerixafor, G-CSF, and combinations) and B-ALL (standard chemotherapy, HSCT, blinatumomab, tisagenlecleucel, and combinations). All studies employed decision analytic models including Markov cohort (n=2), microsimulation (n=3), or partitioned survival (n=2). Median (range) reported lifetime costs for DLBCL and B-ALL were $68,821 ($42,790-$114,638) and $374,000 ($214,452-$968,800), respectively. Median (range) B-ALL costs excluding CAR-T therapies were $337,000 ($214,452-$440,600). Most studies (86%) did not report indirect costs.

CONCLUSIONS: Few studies research remaining lifetime healthcare cost burdens attributable to DLBCL or B-ALL. Heterogeneity in cost estimates exists by patient population and treatment patterns; however, study findings may also be influenced by authors’ methodological assumptions. Improved data and standardized methods are necessary to obtain accurate and precise estimates of the lifetime economic burdens for DLBCL and B-ALL.