OBJECTIVES: Examine treatment patterns and costs among patients treated for FL or MZL.

METHODS: Patients included U.S. commercial and Medicare Advantage health plan members diagnosed with FL or MZL and treated between 01-Jan-2008 and 31-Jan-2018. The first line of therapy (LOT) started with the first claim for a systemic cancer therapy, and the regimen included all medications with claims within 30 days. LOT 2 started with a claim for a new therapy.

RESULTS: There were 2,161 FL patients (mean 67y; 50% male) and 1,162 MZL patients (mean 68y; 45% male). The percent of patients without an NCCN-recommended agent generally increased by LOT: 5%(99/2,161), 11%(77/699), 15%(46/315), and 12%(20/171) in FL LOTs 1-4, respectively, and 11%(124/1,162), 25%(107/427), 29%(51/178), and 32%(29/90) in MZL LOTs 1-4. Rituximab monotherapy and bendamustine-rituximab were the most common regimens. Median per patient per month (PPPM) costs for bendamustine-rituximab for FL during LOTs 1-3 (LOT 4 not reported due to sample size) were $16,614 (n=668; interquartile range [IQR]=$10,598-$22,866), $18,036 (n=107; IQR=$10,493-$24,933), and $17,627 (n=20; IQR=$11,130-$29,615), respectively. Median PPPM costs for rituximab monotherapy for FL during LOTs 1-4 were $14,018 (n=575; IQR=$6,801-19,919), $13,247 (n=279; IQR=$4,967-$17,385), $14,695 (n=146; IQR=$10,172-$19,579), and $15,109 (n=99; IQR=$10,924-$21,921). Median PPPM costs for bendamustine-rituximab for MZL during LOTs 1-3 (LOT 4 not reported due to sample size) were $17,574 (n=150; IQR=$11,179-$25,070), $17,882 (n=46; IQR=$13,252-$23,747), and $17,177 (n=15; IQR=$10,375-$20,949). Median PPPM costs for rituximab monotherapy for MZL during LOTs 1-4 were $14,948 (n=535 ; IQR=$8,770-$20,866), $13,210 (n=166; IQR=$6,999-$20,312), $14,524 (n=67; IQR=$8,161-$18,961), and $13,366 (n=39; IQR=$8,682-$16,738).

CONCLUSIONS: FL and MZL were often treated with rituximab +/- chemotherapy and, particularily in later LOTs and for MZL, non-recommended medications. Although there was high variability (i.e. large IQRs), the highest costs during the most common regimens were typically in LOTs 2+ for FL and followed no clear pattern for MZL.