Economic Burden and Healthcare Resource Utilization in Patients with Relapsed or Refractory MCL

Despite the emergence of new therapies such as bruton tyrosine kinase (BTK) inhibitors in the mantle-cell lymphoma (MCL) treatment landscape, treatments for relapsed or refractory MCL are still characterized by common relapses and poor patient outcomes. Aiming to characterize the healthcare constraints posed by relapsed or refractory MCL, this study assessed real-world health resource utilization (HRU) and standard-of-care (SoC) costs by line of therapy.

Utilizing IBM MarketScan Commercial and Medicare Supplemental claims data between January 1, 2016, and December 31, 2020, patients with relapsed or refractory MCL were identified and screened for study inclusion. For patients to be eligible, confirmation of prior treatment with first-line therapy for MCL with a preceding diagnosis of MCL and 6 months of continuous enrollment were required. Second-line therapy was also required, with patients having to be at least 18 years of age by the time of second-line therapy initiation. Patients were excluded if they had been enrolled in clinical trials or were diagnosed with other forms of non-Hodgkin lymphoma. Study end points included duration of each line of therapy, all-cause HRU, inpatient length of stay (LOS), and healthcare costs.

Of 84 patients with relapsed or refractory MCL included in the analysis, 79% were male and 68% had commercial insurance. The median age of patients was 62 years, and the median Charlson Comorbidity Index score was 3.0. Nearly two-thirds (64%) of patients who initiated second-line treatment required third-line treatment, of whom 30% required subsequent lines of therapy. Patients with relapsed or refractory MCL relapsed more quickly with successive lines of treatment, with mean durations of time between therapies for second-line, third-line, and fourth-line and beyond found to be 5.8 months, 6.2 months, and 2.6 months, respectively. With each line of therapy, hospitalization rates increased (41% in second-line; 57% in third-line; 63% in fourth-line and beyond). The mean inpatient LOS was also found to increase, from 7.2 days in first-line to 11.3 days in fourth-line and beyond. Mean monthly costs per patient were found to be high, with $28,164 for second-line treatment, $28,450 for third-line, and $38,911 for fourth-line and beyond. Among patients receiving BTK inhibitors, mean monthly costs per patient were $19,701, $32,098, and $45,031 for second-, third-, and fourth-line treatments and beyond, respectively.

These findings suggest that SoC treatment for relapsed or refractory MCL incurs high costs and HRU within each line of therapy, with frequent relapse. While results should be interpreted with caution due to the small sample size and lack of inclusion of newly approved chimeric antigen T-cell therapy, the authors noted that more effective, durable treatments may be able to reduce the HRU and cost burden associated with relapsed or refractory MCL.

Source:

Ito D, Feng C, Fu C, et al. Health resource utilization and total costs of care for adult patients with relapsed or refractory mantle cell lymphoma in the US: a retrospective claims analysis. Presented at: 2022 Academy of Managed Care Pharmacy Nexus Annual Meeting; October 11-14, 2022; National Harbor, MD. Poster C43.