Adverse Events, Resource Use, and Economic Burden in Patients with Mantle-Cell Lymphoma in the United States

February 2018, Vol 9, No 1 | Payers' Perspectives In Oncology: ASH 2017 Highlights

In patients with mantle-cell lymphoma (MCL), adverse events (AEs) can impair patient adherence to planned therapeutic regimens, and moderate-to-severe AEs generally require medical attention and are often associated with increased healthcare resource use (HRU) and costs. At ASH 2017, the authors presented the results of a retrospective cohort analysis designed to assess HRU and direct costs of MCL, examine variation in costs across treatment types, and document the economic burden associated with MCL treatment-related AEs.1

The study was performed using MarketScan databases containing employer- and health-plan–sourced administrative claims data for more than 60 million privately insured individuals across the United States. Cost information included patient copay, coinsurance, charges, and the actual amounts paid by the payers. Patients were included in the analysis if they had ≥2 medical claims on separate dates with a diagnosis code for MCL and were continuously enrolled in medical and drug plans for ≥12 months before the date of first MCL diagnosis (ie, study index date).

A total of 783 patients with MCL met the study selection criteria. Mean (standard deviation [SD]) all-cause and MCL-related monthly costs were $8393 ($16,276) and $6730 ($14,779), respectively. Inpatient admission costs ($4817 [$14,267]) and office visit costs ($1493 [$3250]) were the largest drivers of total all-cause costs. Among patients receiving systemic therapies, mean all-cause monthly costs were highest for rituximab, cyclophosphamide, doxorubicin, and vincristine (R-CHOP), followed by ibrutinib monotherapy, bendamustine plus rituximab (BR), and rituximab alone (including rituximab maintenance therapy).

The median length of stay per all-cause inpatient admission was 3.0 days (range, 2-4 days) among patients with no AEs, which increased to 5.2 days (range, 1-50 days) among those with ≥6 AEs. A corresponding increase in the length of stay per admission with increasing numbers of AEs was also observed. The mean (SD) all-cause monthly costs were $4298 ($10,082) among those with no AEs and more than 2-fold higher ($10,335 [$16,868]) among those with ≥6 AEs during follow-up.

This was the largest series of patients with MCL in which real-world economic burden data have been reported. The authors concluded that the economic burden of MCL is substantial, with mean monthly costs varying considerably by treatment regimen and care setting. Inpatient admissions and office visits were the largest drivers of total costs for patients treated with R-CHOP, BR, and rituximab, whereas prescription drug costs were the largest component of total costs for patients receiving ibrutinib. Patients experiencing more AEs were observed to have higher monthly costs than those experiencing few AEs.


  1. Karve S, et al. ASH 2017. Abstract 3442.

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