Treatment with Rituximab in Clinics and Offices versus Hospitals

New Orleans—A retrospective analysis of a managed care claims database found that from 2007 to 2012, there was an increase in the proportion of patients who took rituximab to treat diffuse large B-cell lymphoma (DLBCL) in a hospital setting compared with an office or clinic. The authors also concluded that the costs of administering rituximab in the hospital were higher.

The unadjusted mean infusion costs per day were $12,481 in the hospital and $5834 in the office or clinic (P<.01), while the total unadjusted per patient, per month costs were $22,325 in the hospital compared with $15,541 in the office or clinic (P<.01).

The results were presented during a poster presentation at the ASH meeting. The poster was titled Differences in Treatment Patterns and Costs among Diffuse Large B-Cell Lymphoma (DLBCL) Patients Treated in the Clinic vs. the Hospital Outpatient Setting.

Patients with DLBCL, the most common and aggressive subtype of non-Hodgkin’s lymphoma, have a median survival of <1 year if they do not receive treatment. The National Cancer Comprehensive Network guidelines recommend rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone as first line therapy. Rituximab, a CD20-directed cytolytic antibody, is administered intravenously and is FDA-approved to treat non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, and rheumatoid arthritis.

In this study, the authors examined a claims database from a US health plan from January 2007 to July 2012. They included patients who were at least 18 years of age, had commercial insurance or Medicare Advantage with medical and pharmacy benefits, had evidence of DLBCL but no other primary cancers, and had at least 2 claims for rituximab. Patients were examined during an episode of care, which the authors defined as from the first infusion of rituximab to 30 days after the last infusion prior to a gap of at least 7 months.

Of the 491 patients, 320 received rituximab in an office or clinic and 171 received the drug in a hospital. At baseline, the groups were well-balanced. The mean age was 61 years, 54% of patients were male, 71% had commercial insurance, and the baseline comorbidity index was 3.55.

In 2007, 32% of patients received the drug in a hospital setting compared with 68% in an office or clinic. In 2012, 43% of patients received the drug in a hospital setting compared with 57% in an office or clinic.

The mean number of rituximab infusions was 4.92 in the hospital group and 6.52 in the office or clinic group (P<.01), while the mean number of infusions per month was 1.01 and 1.17, respectively (P<.01). The mean length of the episode of care was 187 days in the office or clinic and 178 days in the hospital (P=.489).

In addition, 93% of patients in the office or clinic group received rituximab plus chemotherapy compared with 85% in the hospital group (P<.01), while 87% and 77% of patients, respectively, had evidence of receiving granulocyte-colony stimulating factor at least once during the episode of care (P<.01).

The incidence rates of emergency visits were significantly higher in the hospital group, although there was no difference in the incidence rates of hospitalizations.

The authors noted a few study limitations, including that it could not be determined if there was an association between the site of treatment and difference in quality or outcome measures. The claims data also did not include the reasons patients received infusions and the reasons for the specific treatment choices.

This study was funded by Genentech.