Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma

Abstract

Limited data are available regarding treatment patterns, healthcare resource utilization (HCRU), treatment costs and clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL) in Japan. This retrospective database study analyzed the Medical Data Vision database for DLBCL patients who received treatment during the identification period from October 1 2008 to December 31 2017. Among 6,965 eligible DLBCL patients, 5,541 patients (79.6%) received first-line (1L) rituximab (R)-based therapy, and then were gradually switched to chemotherapy without R in subsequent lines of therapy. In each treatment regimen, 1L treatment cost was the highest among all lines of therapy. The major cost drivers i.e. total direct medical costs until death or censoring across all regimens and lines of therapy were from the 1L regimen and inpatient costs. During the follow-up period, DLBCL patients who received a 1L R-CHOP regimen achieved the highest survival rate and longest time-to-next-treatment, with a relatively low mean treatment cost due to lower inpatient healthcare resource utilization and fewer lines of therapy compared to other 1L regimens. Our retrospective analysis of clinical practices in Japanese DLBCL patients demonstrated that 1L treatment and inpatient costs were major cost contributors and that the use of 1L R-CHOP was associated with better clinical outcomes at a relatively low mean treatment cost.

Economic Burden in Treated Japanese Patients with Relapsed/Refractory Large B-Cell Lymphoma

“…The identification period of this study was designed based on a prior Japanese study on DLBCL patients [ 8 ], from 1 October 2008 through 31 December 2018 for the main analysis cohort, from 1 March through 30 June 2019 for the pre-COVID-19 subgroup, and from 1 March through 30 June 2020 for the post-COVID-19 subgroup ( Supplementary Figure 1A & B , respectively). Patients included in this study were those with a minimum look-back period of 6 months and a minimum follow-up period of 12 months relative to their index date.…”

“…Patients included in this study were those treated for r/r DLBCL during the look-back and identification periods, and who had claims with an International Classification of Diseases (ICD-10) diagnosis code for DLBCL (C83.3x, C85.2x, Japanese receiptcode 8847286) on the date of their first DLBCL treatment or within 6 months prior to their first treatment date [ 8 ]. The date of their first DLBCL treatment was designated as the first treatment date, and the date of initiation of 2L or 3L DLBCL treatment was designated as the index date.…”

“…In a prior retrospective database study, approximately 70% of patients with DLBCL in Japan were found to be aged 65 years and over [ 7 ], with more than 20% aged 80 years and above [ 8 ]. As the recommended age limit for eligibility for auto-SCT is 65 years and early 70s for allogeneic stem cell transplant (allo-SCT) for those who are neither eligible for auto-SCT transplant nor failed [ 9 ], a substantial proportion of DLBCL patients require alternative therapies.…”

“…Additionally, patients with r/r DLBCL who are not candidates for high-dose therapy are not considered eligible for SCT [ 10 ], and patients with double-hit lymphomas or double-expressor lymphomas have been found to have inferior progression-free survival associated with auto-SCT [ 11 ]. Such patients are therefore treated with salvage chemotherapy regimens or radiation therapy as palliative treatment [ 8 , 10 ]; these treatments are not for curative intent and prognosis remains poor due to both the aggressive nature of the disease and the heterogeneous clinicobiological profiles of r/r DLBCL patients [ 12 , 13 ]. Furthermore, uncertainties in the timing of relapse and progression found in several studies – including a significant risk of relapse of DLBCL after auto-SCT – result in a requirement for continued monitoring and a need for better prognostic tools to be established for better clinical decision-making [ 14 , 15 ].…”

“…To our knowledge, there is no standard treatment regimen or definite treatment consensus for patients with r/r DLBCL who are not eligible for auto-SCT or who relapse after auto-SCT [ 8 ]. Recently, chimeric antigen receptor T-cell (CAR-T) therapies have been approved to treat such a population.…”