Cost of Disease Progression in Diffuse Large B-Cell Lymphoma After Frontline Treatment With Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone.

Background: In recent years, novel agents have become available to treat relapsed/refractory diffuse large B-cell lymphoma (DLBCL); the impact of such agents on treatment costs has not been formally studied. We present results from 2 independent, retrospective, real-world cohort analyses to determine the cost of disease progression after first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).
Materials and Methods: Analyses were conducted using the IQVIA PharMetrics ^Ⓡ Plus claims database and the Surveillance, Epidemiology, and End Results registry-Medicare-linked database (SEER-Medicare) and included patients ≥18 years and ≥66 years, respectively. "No progression" was defined as no second-line therapy for ≥2 years after the end of first-line R-CHOP and "treated progression" as initiating a second-line therapy within 2 years following the end of first-line R-CHOP. Analyses were adjusted for baseline covariates, and per-patient-per-month (PPPM) costs were compared between progressors and nonprogressors.
Results: The IQVIA PharMetrics Plus analysis (January 1, 2010-June 30, 2018) included 871 patients (nonprogressors, n = 725; progressors, n = 146), including 10 patients who received chimeric antigen receptor T-cell therapy (CAR-T). Treated progression was associated with significantly higher adjusted PPPM costs than no progression ($10,554 vs. $1561, P < .001). The SEER-Medicare analysis (January 1, 2010-December 31, 2017) included 4099 patients (nonprogressors, n = 3389; progressors, n = 710), including 12 patients receiving CAR-T. Treated progression was associated with significantly higher adjusted PPPM costs than no progression ($10,928 vs. $2902, P < .001).
Conclusion: Treated progression of DLBCL increases adjusted PPPM costs by over $8000 compared with no progression.
Competing Interests: Disclosure John M. Burke reports consultancy or advisory role for AbbVie, Adaptive Biotechnologies, AstraZeneca, Bayer, BeiGene, Bristol-Myers Squibb, Constellation, Epizyme, Inc., F. Hoffmann-La Roche Ltd, Genentech, Inc., Genmab, Kura, Kymera Therapeutics, Lilly, MorphoSys, Nurix, Seagen, TG Therapeutics, and X4 Pharmaceuticals; speakers bureau for BeiGene and Seagen. Anthony Masaquel, Rongrong Wang, Farah Hossain, Jia Li, Carmen D. Ng are employees of Genentech, Inc., and receive F. Hoffmann-La Roche Ltd. stocks/stock options. Summera Qiheng Zhou is a paid consultant of Genentech, Inc. Matthew Matasar reports stock or other ownership for Merck Sharp & Dohme; honoraria for Genentech, Inc., F. Hoffmann-La Roche Ltd, GlaxoSmithKline, Bayer, Pharmacyclics, Janssen, Seattle Genetics, and ImmunoVaccine Technologies; research funding for Genentech, Inc., F. Hoffmann-La Roche Ltd, GlaxoSmithKline, Bayer, Pharmacyclics, Janssen, Seattle Genetics, Rocket Medical, and ImmunoVaccine Technologies.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)