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Cost and Burden of Follicular Non-Hodgkin Lymphoma Disease Progression


Tim Casey

Orlando—A retrospective claims database analysis found disease progression among patients with follicular non-Hodgkin lymphoma (f-NHL) was associated with a $2647 higher per patient per month (PPPM) cost and higher healthcare utilization compared with patients who did not progress in the outpatient community setting. The researchers also concluded that treatments that delay or prevent f-NHL progression improve clinical outcomes and lower cost of care. The results were presented during a poster session at the ASH meeting in a poster titled Economic Impact of Disease Progression in Follicular Non-Hodgkin’s Lymphoma. A slow-growing, indolent subtype of NHL, f-NHL is characterized by continuous risk of relapse and progression and accounts for approximately 20% to 25% of all NHL and 70% of indolent lymphomas. Treatment options for f-NHL include watchful waiting and intensive therapies aimed at delaying disease relapse and progression with the fewest adverse effects, although managing f-NHL is challenging. In this trial, the first to estimate the cost of f-NHL and its burden on the healthcare system, the authors linked data from US Oncology’s iKnowMed (iKM) electronic medical record to US Oncology’s Claims Data Warehouse (CDW). The CDW includes Current Procedural Terminology codes, Healthcare Common Procedure Coding System codes, dates of service, quantity, amount billed, and the primary payer. Patients were included in the trial if they had f-NHL, completed first-line chemotherapy, and achieved partial or complete remission or had documented stable disease from July 1, 2006, through February 29, 2008. They were excluded if they had enrolled in clinical trials, received care for another cancer during the study’s time period, had a second opinion or consult only, or had electronic medical record data that did not link to the CDW. The study had 2 cohorts based on progressive disease (PD): the PD cohort was identified by a documented disease status of PD in the iKM, while the non-PD cohort had a documented disease status of partial remission, complete remission, or stable disease. The PD cohort had 204 patients with a mean age of 60.9 years and included 52% females. The non-PD cohort had 798 patients with a mean age of 59.9 years and included 58% females. At baseline, the PD cohort was more likely to have been diagnosed with advanced disease, have ≥4 positive lymph nodes, have worse Eastern Cooperative Oncology Group performance status, and high lactate dehydrogenase levels and low hemoglobin levels compared with the non-PD cohort. In addition, compared with the non-PD cohort, PD patients had a significantly higher frequency of chemotherapy visits, outpatient visits, and laboratory procedures (P<.001 in each case). The authors considered costs from a payer’s perspective and made estimates based on unadjusted Medicare reimbursement rates. Economic outcomes were calculated as a PPPM metric over a 6-month follow-up period. The cumulative 6-month total cost for the PD cohort was $21,496 compared with $5165 for the non-PD cohort, while the average cost PPPM was $2647 more for PD patients. The differences in PPPM costs were statistically significant in each category: outpatient visits, acute therapy, chemotherapy, other medications, laboratory, minor procedures, nursing care/hospice care, external radiation therapy, and nonexternal radiation therapy. The authors cited some study limitations. The data were subject to selection bias, and the study population may differ in unknown ways from the underlying patient population. Confounding variables such as race, ethnicity, and income were not available, limiting the covariate analysis. In addition, because the patients were followed for a maximum of 6 months, the authors mentioned they could have underestimated reported costs and rate of treatment failure or PD. Finally, the radiologic service costs and inpatient consultation visits could have been underestimated if patients received care outside of US Oncology’s network.

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