Healthcare Costs Skyrocket for Patients with Relapsed Lymphoma

A new study found a significant financial burden associated with increased healthcare utilization among patients with relapsed diffuse large B-cell lymphoma.

Diffuse large-B cell lymphoma is the most common type of non-Hodgkin lymphoma, accounting for 30% of new cases in the United States each year. While some cases can occur in children and younger adults, it is most common in patients age 60 and older, according to the Lymphoma Research Foundation.

Investigators in the study used Medicare claims data to determine the likelihood of healthcare utilization after patients completed first-line treatment for the cancer. The results were presented at the American Society of Hematology meeting.

Included in the study were 5909 Medicare beneficiaries age 65 and older, who were diagnosed with diffuse large B-cell lymphoma between 2010 and 2014, and completed the first-line treatment. First-line treatment is typically R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), and sometimes the chemotherapy drug etoposide is added to the regimen.

All patients included in the study had continuous health coverage through Medicare for at least 12 months prior to treatment.

Of the 5909 patients treated, 1552 patients also had claims for a second-line treatment during the follow-up period, according to the study. Second-line treatments may include high-dose chemotherapy along with an autologous stem cell transplant, according to the Research Foundation.

Patients who experienced a relapse were significantly more likely to utilize healthcare services compared with patients who achieved remission after first-line treatment, according to the study.

Approximately 60.7% of patients who relapsed were admitted to the hospital during follow-up compared with patients who did not relapse. Also, 51.7% of relapse patients visited the emergency department compared with 43% of non-relapsed patients.

The use of in-home and out-of-home care also increased in patients who relapsed after first-line treatment for diffused B-cell lymphoma (DLBCL). Skilled nursing facilities were utilized by 19.3% of patients who relapsed compared with 12.5% of patients who did not, according to the study.

Home health agencies were used by 35.5% and 23.3% of patients who relapsed and those who did not, respectively. Hospice services were used by 19.9% of patients who relapsed compared with 6.3% of patients who achieved remission.

Investigators also discovered that all-cause healthcare costs were significantly higher among patients who relapsed. On average, these patients incurred $6566 in healthcare costs compared with $1951 for patients who did not relapse.

“Significant numbers of Medicare beneficiaries treated for DLBCL experience progressive disease and receive therapy beyond the first-line setting,” said senior author of the study Scott Huntington, MD, MPH. “It's evident that improvements in first-line DLBCL therapy in older adults may offer significant health care savings in addition to improved clinical outcomes for these patients.”