Nathan Fowler, MD, MD Anderson Cancer Center, Houston, Texas, discusses results from a study of commercially insured patients with follicular lymphoma (FL), which highlight the high economic burden associated with the disease. These results were published in the Journal of Health Economics and Outcomes Research (2020;7(2):148-157. doi:10.36469/jheor.2020.16784).
Transcript
Hi. My name's Dr. Nathan Fowler from the MD Anderson Cancer Center. I wanted to share with you a recent paper that we published in the Journal of Health Economics and Outcomes Research. This was a study looking at treatment patterns and health care costs of patients with insurance that received treatment for follicular lymphoma.
As a brief background, follicular lymphoma is one of the more common non-Hodgkin's lymphoma. It's generally thought of as an incurable disease in the vast majority of people. Although the majority of people respond to first-line regimens, often with some type of immunotherapy or chemotherapy, many patients will eventually relapse.
Many times, that relapse occurs in the first 5 to 10 or so years. Subsequent relapses have shorter durations, in general. Many times, if you look across the natural history of the disease, patients can have 3, 4, 5 lines of therapy sometimes.
The purpose of this article was really to explore the financial burden that comes with multiple treatments, especially in patients that have a chronic disease. What we did is we retrospectively collected patients from several market databases that were treated between 2010 and 2013.
We went back that far because we wanted patients that had some follow-up that we could understand, again, the impact of several lines of different treatment. All the patients, to be included in this study, had to be followed for at least 48 months from, I guess, initiating therapy. We identified nearly 600 patients, 598 patients, who initiated follicular lymphoma treatment.
The average follow-up for this study or, I guess, the time from starting our study was 5.7 years. About half of the patients were male. Half were female. In this follow-up, all patients had at least 1 line of therapy as dictated by the eligibility to get on this retrospective study.
Around half of them eventually received some second-line therapy. 51 patients, around 10%, had third-line therapy. A few patients had fourth- and fifth-line therapy.
As you can imagine if you know the field, we found that the most common regimens in the first line were bendamustine and rituximab or R-CHOP or R-CVP. In second line, we saw things like rituximab, bendamustine and rituximab, and some other targeted therapies.
Interestingly, if you look at the annualized all-cause healthcare costs per patient—this includes costs associated with treatment, costs associated with scans, costs associated with doctors' visits, occasionally to ER or inpatient admissions—they were really, really quite high.
The average annualized all-cause healthcare costs for patients in their first line of treatment was $97,000. By the time patients reach their fifth line of therapy, this was often over $400,000 per year.
You can imagine, in patients that have a chronic disease, and many times will reach their second or third or fourth line of therapy, these kind of healthcare costs can be very significant and often crippling.
I think we need to clearly, as a field, identify ways to minimize these costs, whether that's looking at ways to reduce the healthcare burden with regards to drugs, scanning, as well as ancillary visits or comorbid conditions that can sometimes come with treatment and with dealing with this disease.
I would encourage you to check this article out online. Again, it's in the Journal of Health Economics and Outcomes Research. Thanks again for your attention.
