Matthew Matasar, MD, Memorial Sloan Kettering Cancer Center, New York, NY, discusses the substantial economic burden among patients with relapsed/refractory follicular lymphoma (FL) who require 3 or more lines of therapy. 

This study was presented at the virtual 2021 ASH Annual Meeting in Atlanta, GA.

Transcript: 

Hi. I'm Dr. Matthew Matasar from the Memorial Sloan Kettering Cancer Center. Today, I'm going to be speaking about the abstract entitled “Healthcare Resource Utilization and Costs of Patients With Relapsed or Refractory Follicular Lymphoma Receiving Three or More Prior Lines of Therapy.”

As is well known to those of you who are watching this video, follicular lymphoma is a common form of indolent B-cell non-Hodgkin's lymphoma. By its nature, it tends to be chronically relapsing. Patients will often require multiple lines of therapy over the course of their illness.

Unfortunately, we don't have a complete picture as of the present as to the actual economic impact of multiply relapsed follicular lymphoma, and really a very limited sense of information in terms of the real-world economic burden of patients with relapsed or refractory follicular lymphoma receiving third-line or beyond treatment for this disease.

Our study aims to examine real-world health care resource utilization and costs among patients with follicular lymphoma therapies in the third-line setting and beyond.

What we did is we performed a retrospective cohort study using an administrative claims database from the IQVIA PharMetrics Plus database, looking between the years of 2011 and 2020, examining patients who received treatment for follicular lymphoma in the third-line or beyond.

We did this via two ways: the first was to identify patients who had three or more lines of therapy during the conduct years of the study, the second was to identify patients who received treatment with PI3K inhibitors, which are specifically approved and companion-listed only for the treatment of follicular lymphoma in the third-line and beyond.

We then went and looked at annualized health care resource utilization and costs over the conduct of the trial.

In all, we found a hundred patients who met our study criteria, approximately evenly split between men and women and distributed geographically relatively homogeneously across the country.

In looking at the treatments that were delivered in the third-line and beyond, we found that these were distributed among chemoimmunotherapy, monoclonal antibody therapy as monotherapy, and PI3K inhibitor therapy with a smattering of other treatments as well.

When we look at the actual all-cause costs for the third-line and beyond and by line of therapy, we found that the annualized all-cause total cost for patients with third-line and beyond treatment for follicular lymphoma came to almost $200,000 per annum.

This was about $190,000 for the third-line, and for fourth-line patients, of whom we had 44, this rose to over $290,000.

When you look at these costs and how they break down, certainly, follicular-lymphoma-related total cost made up the lion's share of this overall total cost.

When you break this down further in terms of third-line and fourth-line in terms of medical costs, pharmacy costs, and administration costs, we see that the overall costs do go up between third and fourth-line when you're looking at specific follicular-lymphoma-related treatment costs. That's across all these underlying categories.

When looking at the different treatment types, with the most common ones being chemoimmunotherapy, monoclonal antibody monotherapy, and oral PI3Ks, we did find that there were differences in total costs among these categories of therapies.

With the least expensive in the third-line being monoclonal antibody monotherapy followed by oral PI3K inhibitors, and the most expensive being chemoimmunotherapy at $120,000, $160,000, and $250,000 per year respectively.

When looking at the fourth-line, these flattened a little bit, with oral PI3Ks now costing $180,000 per year, chemoimmunotherapy, $200,000, and monoclonal antibody therapy being associated with $220,000 a year.

These costs obviously differ in terms of the category breakdowns, with pharmacy costs driving the total cost for oral PI3K inhibitor therapy and making up the least for monoclonal antibody therapy, whereas hospital visits and other outpatient charges increased incrementally for that category.

In conclusion, what we did find is that there is a very high economic burden for patients with relapsed or refractory follicular lymphoma requiring treatment in the third-line or beyond, and that follicular-lymphoma-related costs really do make up a majority of these total health care costs.

More than 40% of our patients required a fourth-line or beyond treatment after third-line therapy, which further compounds the challenges faced by this higher-risk patient population. We found that all-cause total health care does increase in total cost from third-line to fourth-line.

There are some limitations to this study, including the assumption that PI3K inhibitors were only being given for third-line therapy for follicular lymphoma and not fourth-line or beyond, and there's always a chance for misclassification when using claims data.

However, our analysis really does provide the first benchmark for assessing cost and impact of the cost in patients with relapsed or refractory follicular lymphoma in the third-line or beyond.

This is important, as we have new treatments for multiply relapsed follicular lymphoma that have become recently available, such as CAR T-cell therapy, and new treatments that may become available in the clinic in the months or years to come, including bispecific antibody therapy.

Thank you for your attention.