Karl Kilgore, PhD, Avalere Health, An Inovalon Company, Washington, DC, discusses study results comparing patient characteristics, treatments, costs, and overall survival between Medicare beneficiaries with large B-cell lymphoma (LBCL) who received stem cell transplantation versus those who did not.
These results were presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting.
Transcript
Hi. I'm Karl Kilgore, Senior Research Scientist at Avalere Health, an Inovalon company, in Washington, DC. I'd like to share with you some of the results of a study we presented at ASH 2020.
The title of the study, "Burden of Illness and Outcomes in the 2nd Line Treatment of Large B-Cell Lymphoma: A Real-World Comparison of Medicare Beneficiaries With and Without Stem Cell Transplants."
The purpose of the study was to take a sample of patients using the CMS Medicare fee-for-service 100% claims data to look at a sample of patients with relapsed/refractory diffuse large B-cell lymphoma. These were patients who relapsed or refracted after receiving standard first-line chemotherapy for their DLBCL.
Standard of care for these patients is platinum-based chemotherapy as preparatory regimen for autologous stem cell transplants. We looked at treatments, health care utilization, costs in this group of patients from the initiation of second-line therapy on to death or loss to follow-up or disenrollment.
What did we find in this claims analysis? First, as I said, standard of care for these patients who relapse or refract after standard first line is preparatory regimens for stem cell transplant. We used NCCN guidelines to look at the second line therapies that these patients received. NCCN categorizes those regimens into intended for stem cell transplant, SCT, versus not intended.
The first thing we found was that over 75% of these patients who were relapsed/refractory—we had about 4,500 patients, total. A little under 4,000 of them never received a second-line regimen, second-line or higher regimen, where they were intended for stem cell transplant. About 78% of them never were even intended to get a stem cell transplant.
Of the remaining patients, a little over 1,000 patients, over 75% of those received a second-line regimen that was intended for stem cell transplant, but they never received a stem cell transplant. Either they didn't respond to the second-line treatment, or they couldn't tolerate the treatment.
Let's go on to quickly to health care utilization and costs, focusing on the SCT-intended patients, the group that received a second-line regimen that showed they were intended for stem cell transplant, and compare those who received the transplant with those who didn't.
Those who received a transplant were about 5 years younger and had slightly lower comorbidity scores. Otherwise, the 2 groups were very similar. The non-stem cell transplant group, in terms of health care utilization and costs, had higher utilization and costs for all categories that we looked at, outpatient, physician office visits, drugs, post-acute care.
The non-stem cell transplant group in the follow-up period, the period after second-line treatment, had higher utilization and higher costs in all categories except for acute inpatient. Most of that difference was due to the stem cell transplant procedure itself. That was true, higher utilization and cost, with the exception of inpatient, was true for all cause as well as LBCL-related treatment.
Finally, in the treatments that they received post-second line, almost 40% of the patients who did not get a stem cell transplant continued to get LBCL-directed chemotherapy beyond second line compared to only 7% of the stem cell transplants.
Which we interpret to mean their providers felt that even though they didn't get a transplant— they weren't eligible for or couldn't tolerate a transplant—there was still benefit to continue treatment for those patients who didn't get stem cell transplant.
To summarize, patients in our study, over 75% of patients who relapsed or refracted after standard first-line LBCL treatment, 78% of them never even received a second-line regimen that showed they were intended for stem cell transplant.
Of those who did receive a second-line regimen intended for transplant, over 75% never got a transplant. Cost and utilization in the follow-up period post second-line treatment was higher for the non-stem cell transplant patients in all categories except for inpatient.
Almost 40% of the patients who didn't get a stem cell transplant continued to receive LBCL-related treatments. Taken altogether, taking these findings together, in the elderly relapsed/refractory patients, there appears to be an unmet need in patients who do not qualify or never receive a stem cell transplant.
