Economic impact of disease progression in follicular non-Hodgkin lymphoma

Figures & data

Table I. Patient characteristics at baseline.

Characteristic	Total (n = 1002)	No progression (n = 734)	Progression (n = 268)	p-Value
Age at diagnosis, n (%)
< 55	333 (33)	258 (35)	75 (28)	0.10
55–65	313 (31)	222 (30)	91 (34)
> 65	356 (36)	254 (35)	102 (38)
Mean age	60.1	59.6	61.3
Median age (range)	61 (21–91)	60 (21–91)	61 (27–90)	0.10
Gender, n (%)
Female	565 (56)	430 (59)	135 (50)	0.02
Male	437 (44)	304 (41)	133 (50)
Stage, n (%)
I	187 (20)	147 (21)	40 (16)	0.06
II	198 (21)	150 (22)	48 (19)
III	234 (25)	170 (25)	64 (25)
IV	327 (35)	223 (32)	104 (41)
Missing	56	44	12
B-symptoms, n (%)
No	812 (85)	601 (87)	211 (82)	0.11
Yes	138 (15)	93 (13)	45 (18)
Missing	52	40	12
HGB < 12*, n (%)
No	668 (81)	502 (85)	166 (73)	< 0.0001
Yes	152 (19)	90 (15)	62 (27)
Missing	182	142	40
Elevated LDH*, n (%)
No	477 (86)	353 (89)	124 (80)	0.01
Yes	76 (14)	45 (11)	31 (20)
Missing	449	336	113
4 + positive nodes, n (%)
No	543 (67)	412 (70)	131 (58)	0.0008
Yes	272 (33)	176 (30)	96 (42)
Missing	187	146	41
ECOG PS*, n (%)
0	581 (68)	445 (71)	136 (60)	0.0005
1	209 (25)	145 (23)	64 (28)
2 +	60 (7)	33 (5)	27 (12)
Missing	152	111	41
Payer type
Private	438 (44)	330 (45)	108 (40)	0.06*
Medicare	537 (53)	381 (52)	156 (58)
Medicaid	9 (1)	6 (1)	3 (1)
Other	18 (2)	17 (2)	1 (0)
Follow-up time, n (%)
< 12 months	56 (6)	28 (4)	30 (11)
≥ 12 months	938 (94)	700 (96)	236 (89)
Mean follow-up time, months	35.1	37.0	29.8
Median follow-up, months (range)	37 (1–53)	39 (3–53)	32 (1–53)
Alive at end of follow-up, n (%)	983 (99)	725 (99.6)	258 (97)

HGB, hemoglobin; LDH, lactate dehydrogenase; ECOG PS, Eastern Cooperative Oncology Group Performance Status.

*Based on entry in iKnowMed closest to index date (± 14 days).

Table II. Description of infusion therapy by progression status after index date.

Infused therapy	Total (n = 1002)	No progression (n = 734)	Progression (n = 268)
Infusion therapy
No	621 (61.9%)	539 (73.4%)	82 (30.5%)
Yes	381 (38.1%)	195 (26.5%)	186 (69.4%)
Rituximab monotherapy	216 (21.6%)	147 (75.4%)	69 (37.1%)
Rituximab-chemotherapy	154 (15.4%)	44 (22.5%)	110 (59.1%)
Chemotherapy only	11 (1.1%)	4 (2.1%)	7 (3.8%)
Chemotherapy agents
Rituximab-chemotherapy	154	44	110
Cyclophosphamide	108	33	75
Vincristine	101	32	69
Doxorubicin	41	16	25
Fludarabine	23	3	20
Other	203	46	157
Chemotherapy only	11	4	7
Cyclophosphamide	6	2	4
Vincristine	4	1	3
Doxorubicin	2	1	1
Etoposide	1	1	0
Other	10	2	8

Figure 1. Cumulative 12-month total cost by progression status.

Table III. Six-month mean cost per patient per month overall and by category.

Service	No progression (n = 734)	Progression (n = 268)	CP − CNP	CP/CNP	p-Value*
Overall cost	859.98	3527.4	2667.4	4.10	<0.001
Outpatient visits	36.68	99.92	63.24	2.72	<0.001
Acute care^†	2.46	24.14	21.68	9.81	<0.001
Chemotherapy	655.75	2495.01	1839.26	3.8	<0.001
R-mono	487.07	849.50	362.43	1.74	<0.001
R-chemo	166.07	1610.86	1444.79	9.69	<0.001
Chemo	2.61	34.65	32.04	13.27	<0.001
Other medication	101.86	700.28	598.42	6.87	<0.001
Laboratories	11.35	28.53	17.18	2.51	<0.001
Minor procedures	2.79	8.79	6.00	3.15	<0.001
Other	0.59	3.02	2.43	5.11	<0.001
XRT	15.07	71.27	38.93	4.72	<0.001
RAD non-XRT	32.59	95.41	62.82	2.92	<0.001

C_P, cost of progression; C_NP, cost of not progressing; R-mono, rituximab monotherapy; R-chemo, rituximab-chemotherapy; Chemo, chemotherapy only; XRT, external radiation treatment; RAD non-XRT, radiation other than XRT.

*Mann–Whitney U-test.

^†Inpatient and ER visits.

Table IV. Multivariable regression analysis of mean cost per patient per month.

Covariate	Untransformed model			Log-transformed model
	Coefficient	95% CI	p-Value	Coefficient	95% CI	p-Value
Progression status
No	Referent			Referent
Yes	2557.20	2090.90–3023.49	<0.001	2.29	1.94–2.64	<0.001
Hemoglobin <12
No	Referent			Referent
Yes	783.65	283.73–1283.57	0.002	1.01	0.64–1.38	<0.001
4+ positive nodes
No	Referent			Referent
Yes	558.92	166.99–950.84	0.005	0.62	0.28–0.95	<0.001
ECOG PS
0	Referent			Referent
1	611.48	180.07–1042.89	0.006	0.65	0.28–1.02	0.001
2	168.26	602.06–938.60	0.66	0.21	0.36–0.80	0.46

CI, confidence interval; ECOG PS, Eastern Cooperative Oncology Group Performance Status.

Table V. Comparison of healthcare resource utilization by progression status.

Service	No progression (n = 798)	Progression (n = 204)	p-Value
Chemotherapy visits
No	530 (72.2%)	77 (28.7%)	<0.001
Yes	204 (28.8%)	191 (72.3%)
Visits per patient-month*
Mean	0.17	0.88	<0.001
Median (range)	0.16 (0–2.84)	0.66 (0–5)	<0.001
Outpatient physician visits
Visits per patient-month
Mean	0.47	1.23	<0.001
Median (range)	0.33 (0.16–7)	1 (0.16–9.33)	<0.001
Outpatient laboratory procedures
Procedures per patient-month
Mean	0.99	2.46	<0.001
Median (range)	0.66 (0–15.6)	1.5 (0–16)	<0.001
Acute care visits
No	703 (95.7%)	220 (82%)	<0.001
Yes	31 (4.3%)	48 (18%)
Visits per patient-month^†
Mean	1.11	1.72	0.62
Median (range)	0.66 (0.16–3.33)	0.66 (0.16–6.5)	0.62

*Of patients with at least one chemotherapy visit.

^†Of patients with at least one acute care visit.