Administration costs of intravenous chemotherapy in treating peripheral T-cell lymphoma

Figures & data

Table 1. Codes for chemotherapy regimen components and single agent treatments, as described in PTCL NCCN Guidelines v3.2012.

Drug	Codes
Alemtuzumab	J9010
Bortezomib	J9041
Brentuximab vedotin	C9287
Carboplatin	J9045
Cisplatin	J9060, J9062, C9418
Cyclophosphamide	J9070, J9080, J9090, J9091, J9092, J9093, J9094, J9095, J9096, J9097, C9420, C9421
Cytarbine	J9100, J9098, J9100
Denileukin diftitox	J9160
Dexamethasone	J1100, J1094, J8540
Docetaxel	J9170, J9171
Doxorubicin	J9000, J9001, C9415
Epirubicin	J9178
Etoposide	J9181, J9182, J8560, C9414, C9425
Gemcitabine	J9201
Ifosfamide	J9208, C9427
Mesna	J9209, C9428
Methylprednisolone	J1020, J1030, J1040, J7509
Mitoxantrone	J9293
Oxaliplatin	J9263, C9205
Pralatrexate	J9307
Prednisone	J7506, J7510
Romidepsin	J9315
Vincristine	J9370, J9375, J9380
Vinorelbine	J9390, C9940

Figure 1. Selection of patients with PTCL receiving NCCN Guideline recommended IV therapy.

Table 2. Patient characteristics (N = 256).

Patient Characteristic	Count	Percentage
Age^a
Age less than 25	0	0.0
Age 25 to 39	12	4.7
Age 40 to 54	45	17.6
Age 55 to 64	74	28.9
Age greater than 64	125	48.8
Insurance Type^b
Managed care	89	34.8
Medicare	119	46.5
Medicaid	12	4.7
Indemnity	5	2.0
Other^c	31	12.1
Region
Midwest	17	6.6
Northeast	14	5.5
South	140	54.7
Southwest	29	11.3
West	56	21.9

^aAge of the patient in 2009.

^bInsurance type is defined at the time of the index PTCL diagnosis and does not change during the study period.

^cOther includes worker compensation, tricare, and self-pay.

Table 3. PTCL IV visit and PMPM allowables by cost category.

	IV Visit Allowables ($)				PMPM Allowables ($)
Cost Category	Median	Mean	%	Std. Dev.	Median	Mean	%	Std. Dev.
Total	5095.63	5734.79	100.0	4872.76	5917.47	9356.32	100.0	11,426.14
IV Administration	332.67	374.42	6.5	251.19	697.24	918.10	9.8	763.28
Chemotherapy Administration	242.87	302.27	80.7	222.54	557.39	743.61	81.0	605.07
Hydration Administration	0.00	1.35	0.4	9.18	0.00	6.35	0.7	51.35
Therapeutic, Diagnostic, Prophylactic Admin	63.08	70.81	18.9	54.63	111.06	168.15	18.3	180.14
Study IV Drug (for PTCL)	1993.00	4588.13	80.0	4902.45	587.97	6196.24	66.2	11,121.95
Other Visit Related Services	197.78	772.11	13.5	1839.37	705.83	2241.94	24.0	3232.79
Miscellaneous Administration	0.00	28.52	3.7	465.49	0.00	25.77	1.1	105.06
Supplies/Equipment	0.00	0.71	0.1	7.00	0.00	3.55	0.2	28.50
Office Visit/Evaluation and Mgmt Services	0.00	18.22	2.4	45.40	0.00	50.18	2.2	91.62
Other IV Drugs/Specially Admin Oral Drugs	188.76	724.66	93.9	1790.31	620.10	2162.44	96.5	3255.37
Antihypercalcemic Agents	0.00	2.40	0.3	52.28	0.00	7.59	0.4	71.51
Colony-Stimulating Factor	0.00	33.39	4.6	277.46	0.00	135.98	6.3	710.29
Anti-Emetic	184.41	176.37	24.3	201.88	297.14	470.30	21.7	505.46
Use for IV Infusion	0.00	1.20	0.2	5.26	0.00	2.79	0.1	10.86
Corticosteroid for Hypersensitivity	0.00	0.07	0.0	0.85	0.00	0.14	0.0	1.16
Used to Clear (Flush) IV Lines or Catheters	0.00	0.10	0.0	1.33	0.00	0.48	0.0	2.76
H2 Antagonists for Hypersensitivity	0.00	0.41	0.1	1.58	0.00	0.93	0.0	3.35
For Anemia	0.00	0.14	0.0	4.05	0.00	0.14	0.0	1.68
Anticancer Agent Monoclonal Antibody	0.00	497.82	68.7	1705.49	0.00	1471.90	68.1	3189.37
Anticancer Agent Chemotherapy	0.00	2.30	0.3	30.63	0.00	9.13	0.4	77.35
Misc Other Drugs	0.00	10.45	1.4	222.83	0.00	63.04	2.9	381.80

Sample: IV visit (N = 250; 2767 visits) and PMPM (N = 256; 1182 months).

Table 4. PTCL IV visit and PMPM allowables by drug.

Study Drug	No. of Patients^a	%	No. of Visits	IV Visit Allowables ($)
				Total			Study Drug			IV Administration			Other Visit-Related Services
				Mean	SD	%	Mean	SD	%	Mean	SD	%	Mean	SD	%
Total	250		2767	5734.79	4872.76	100.0	4588.13	4902.45	80.0	374.42	251.19	6.5	772.11	1839.37	13.5
CHO^b	164	65.6	747	2738.39	2925.66	100.0	255.91	286.82	9.3	540.16	314.53	19.7	1942.32	2680.60	70.9
Gemcitabine	36	14.4	239	1368.23	614.46	100.0	979.69	601.14	71.6	226.98	68.79	16.6	161.56	195.99	11.8
Romidepsin	27	10.8	236	7614.44	3923.86	100.0	6890.22	3759.81	90.5	365.21	189.26	4.8	359.01	361.40	4.7
Pralatrexate	27	10.8	188	11,065.04	4031.04	100.0	10,591.63	3806.62	95.7	220.56	111.19	2.0	252.85	626.80	2.3
Denileukin diftitox	17	6.8	856	9534.83	4036.92	100.0	8961.62	3931.42	94.0	338.13	109.69	3.5	234.69	854.83	2.5
GemOx	14	5.6	44	9321.72	3309.02	100.0	6364.14	1503.89	68.3	545.98	319.51	5.9	2411.59	2568.53	25.9
Alemtuzumab	12	4.8	215	2158.98	539.82	100.0	1938.60	493.52	89.8	150.21	96.90	7.0	70.16	195.70	3.2
Bortezomib	9	3.6	64	1707.42	270.55	100.0	1444.07	111.59	84.6	126.58	65.33	7.4	136.76	184.04	8.0
GND	8	3.2	28	3281.69	1303.59	100.0	2759.37	1051.40	84.1	354.54	342.05	10.8	167.78	194.71	5.1
CHOP	6	2.4	27	2481.84	1449.76	100.0	682.71	847.73	27.5	794.30	328.84	32.0	1004.83	1114.39	40.5
EPOCH	6	2.4	36	3384.26	5633.34	100.0	234.69	306.39	6.9	662.31	414.65	19.6	2487.26	5191.91	73.5
Other^c	10	4.0	87	2209.01	3363.00	100.0	1013.85	2993.81	45.9	477.51	213.04	21.6	717.65	1408.86	32.5
				PMPM Allowables ($)
Study Drug	No. of Patients^a	%	No. of Months	Total			Study Drug			IV Administration			Other Visit-Related Services
				Mean	SD	%	Mean	SD	%	Mean	SD	%	Mean	SD	%
Total	256		1182	9356.32	11,426.14	100.0	6196.24	11,121.95	66.2	918.10	763.28	9.8	2241.94	3232.79	24.0
CHO^b	163	65.2	545	4082.15	5567.17	100.0	378.81	350.13	9.3	774.60	507.44	19.0	2928.75	5160.54	71.7
Gemcitabine	31	12.4	114	6082.20	7600.80	100.0	4888.96	6744.17	80.4	749.13	617.14	12.3	444.11	631.05	7.3
Pralatrexate	27	10.8	64	31,367.37	13,663.98	100.0	30,065.72	13,153.02	95.9	594.32	315.63	1.9	707.34	577.83	2.3
Romidepsin	26	10.4	79	27,192.37	17,302.29	100.0	24,669.54	16,491.14	90.7	1191.66	679.41	4.4	1331.16	1299.01	4.9
Denileukin diftitox	17	6.8	182	40,074.07	33,701.54	100.0	37,132.06	30,973.76	92.7	1529.51	1509.04	3.8	1411.96	2553.49	3.5
EPOCH	14	5.6	43	5079.75	5586.12	100.0	470.99	391.14	9.3	1535.04	1087.82	30.2	3073.72	4656.80	60.5
GemOx	14	5.6	49	13,108.52	6362.64	100.0	9271.52	5927.02	70.7	742.94	502.60	5.7	3094.06	2696.85	23.6
Alemtuzumab	12	4.8	20	23,608.72	11,380.15	100.0	21,411.80	10,995.22	90.7	1300.43	871.52	5.5	896.49	1857.15	3.8
GND	10	4.0	15	10,043.42	6049.77	100.0	8022.79	4683.76	79.9	1244.68	1446.31	12.4	775.94	785.24	7.7
Bortezomib	9	3.6	13	8531.45	2857.38	100.0	7142.13	1863.49	83.7	659.48	393.57	7.7	729.83	958.92	8.6
CHOP	6	2.4	22	4159.73	2608.91	100.0	867.83	828.29	20.9	1276.16	586.55	30.7	2015.75	2530.01	48.5
Other^c	7	2.8	37	13,263.66	14,599.73	100.0	9497.20	13,479.66	71.6	1808.47	2483.16	13.6	1957.99	2011.67	14.8

Sample: NCCN recommended treatments (N = 250).

^aNumber of patients across study drugs is greater than 250 due to patients receiving different therapies.

^bSince prednisone and dexamethasone can be given orally, CHOP and HyperCVAD may frequently appear as CHO in the data.

^cDrugs with less than five patients were classified as ‘other’.

Figure 2. PTCL IV costs by number of administered therapies during a visit.

Figure 3. ‘Other visit-related costs’ per visit for managed care and Medicare patients.

Table 5. (a) PTCL IV visit allowables by managed care and Medicare breakdown by drug. (b) PTCL PPPM allowables by managed care and Medicare breakdown by drug.

Study Drug	No. of Patients	No. of Visits	IV Visit Allowables ($)
			Total			Study Drug			IV Administration			Other Visit-Related Services
			Mean	SD	%	Mean	SD	%	Mean	SD	%	Mean	SD	%
Alemtuzumab
Managed Care	2	12	3404.01	704.02	100.0	3097.43	743.64	91.0	121.61	125.00	3.6	184.97	453.56	5.4
Medicare	7	118	2033.99	502.18	100.0	1854.89	493.92	91.2	151.47	78.66	7.4	27.64	47.46	1.4
Bortezomib
Managed Care	1	4	1553.42	21.13	100.0	1485.75	0.00	95.6	67.67	21.13	4.4	0.00	0.00	0.0
Medicare	7	53	1725.36	293.17	100.0	1437.06	121.60	83.3	124.91	66.91	7.2	163.40	191.81	9.5
CHO
Managed Care	60	266	3982.65	3550.05	100.0	309.49	248.44	7.8	771.87	322.58	19.4	2901.29	3272.70	72.8
Medicare	73	356	1960.27	2064.08	100.0	196.63	115.97	10.0	396.81	177.43	20.2	1366.83	1997.97	69.7
Denileukin diftitox
Managed Care	4	272	13,034.54	4297.53	100.0	12,353.32	4124.07	94.8	412.51	58.36	3.2	267.45	1469.42	2.1
Medicare	9	332	7844.60	3449.77	100.0	7457.13	3429.94	95.1	296.65	130.57	3.8	90.81	126.11	1.2
EPOCH^a
Managed Care	3	28	4049.87	6248.85	100.0	225.54	347.01	5.6	728.19	444.67	18.0	3096.13	5762.17	76.5
Medicare	1	6	933.93	191.59	100.0	286.15	0.85	30.6	389.00	131.52	41.7	258.78	68.96	27.7
Gemcitabine
Managed Care	8	14	2354.07	621.66	100.0	1792.07	439.61	76.1	309.12	61.80	13.1	252.87	340.73	10.7
Medicare	19	154	1226.86	566.33	100.0	878.79	572.48	71.6	216.23	60.30	17.6	131.84	117.35	10.7
GemOx
Managed Care	5	19	12,215.72	2282.40	100.0	7506.34	1153.59	61.4	831.27	271.12	6.8	3878.12	2677.58	31.7
Medicare	5	12	7157.64	2755.85	100.0	4750.38	1047.61	66.4	368.52	76.50	5.1	2038.75	2306.68	28.5
GND
Managed Care	2	7	4804.83	1265.58	100.0	3579.97	1020.06	74.5	756.30	380.75	15.7	468.56	12.40	9.8
Medicare	3	11	2284.62	798.64	100.0	1910.80	685.73	83.6	298.73	192.14	13.1	75.09	97.87	3.3
Pralatrexate
Managed Care	8	68	13,915.08	4739.64	100.0	13,233.60	4425.09	95.1	341.01	92.38	2.5	340.46	1032.11	2.4
Medicare	14	100	9483.52	2115.53	100.0	9131.97	2091.03	96.3	149.92	29.53	1.6	201.63	105.11	2.1
Romidepsin
Managed Care	10	83	9434.70	5924.23	100.0	8480.72	5749.03	89.9	559.22	193.47	5.9	394.76	294.83	4.2
Medicare	15	141	6626.32	1274.24	100.0	6022.93	1201.84	90.9	262.26	52.35	4.0	341.12	404.88	5.1

Study Drug	No. of Patients	No. of Months	PMPM Allowables ($)
			Total			Study Drug			IV Administration			Other Visit-Related Services
			Mean	SD	%	Mean	SD	%	Mean	SD	%	Mean	SD	%
Alemtuzumab
Managed Care	2	1	41,170.29	12,847.07	100.0	36,101.59	18,425.32	87.7	1771.84	1030.77	4.3	3296.87	4547.49	8.0
Medicare	7	12	19,640.67	8135.83	100.0	18,099.57	8016.53	92.2	1274.03	570.59	6.5	267.07	223.40	1.4
Bortezomib
Managed Care	1	1	4660.25	–	100.0	4457.25	–	95.6	203.00	–	4.4	0.00	–	0.0
Medicare	7	10	8920.28	2827.00	100.0	7318.21	1743.83	82.0	674.76	388.81	7.6	927.31	1010.35	10.4
CHO
Managed Care	60	188	4969.12	4805.80	100.0	437.57	283.16	8.8	1040.40	457.17	20.9	3491.15	4456.70	70.3
Medicare	72	274	2994.00	3001.48	100.0	274.17	165.01	9.2	556.21	309.38	18.6	2163.63	2896.02	72.3
Denileukin diftitox
Managed Care	4	42	65,959.94	53,756.84	100.0	59,632.24	47,226.74	90.4	3054.81	2604.30	4.6	3270.56	4952.37	5.0
Medicare	9	96	29,635.67	26,140.48	100.0	28,393.21	26,429.50	95.8	834.67	456.84	2.8	407.78	401.31	1.4
EPOCH
Managed Care	7	18	7984.79	6788.90	100.0	634.42	439.51	7.9	2171.18	1203.57	27.2	5179.20	5963.94	64.9
Medicare	4	18	1663.78	490.44	100.0	360.52	336.16	21.7	793.42	319.18	47.7	509.84	207.50	30.6
Gemcitabine
Managed Care	6	4	15,313.13	14,272.03	100.0	12,482.41	13,055.75	81.5	1687.68	843.27	11.0	1143.04	925.50	7.5
Medicare	19	76	3480.86	1672.49	100.0	2736.84	1739.25	78.6	521.78	210.86	15.0	222.25	284.98	6.4
GemOx
Managed Care	5	20	17,583.50	6564.06	100.0	11,961.93	7935.27	68.0	1271.35	417.70	7.2	4350.23	3123.79	24.7
Medicare	5	8	10,323.40	3700.51	100.0	6694.35	1154.28	64.8	534.26	79.94	5.2	3094.80	2685.52	30.0
GND
Managed Care	4	4	13,434.19	7325.32	100.0	9721.31	4833.57	72.4	2352.53	1722.84	17.5	1360.35	979.99	10.1
Medicare	3	6	5770.40	2715.78	100.0	4669.46	2300.44	80.9	773.48	696.00	13.4	327.46	75.98	5.7
Pralatrexate
Managed Care	8	23	39,824.95	16,717.88	100.0	38,023.03	16,142.98	95.5	878.56	372.40	2.2	923.36	764.19	2.3
Medicare	14	35	28,256.89	11,345.81	100.0	27,169.96	10,958.63	96.2	470.14	158.44	1.7	616.79	514.84	2.2
Romidepsin
Managed Care	9	24	32,709.43	17,929.01	100.0	29,068.09	17,032.78	88.9	1958.37	518.40	6.0	1682.98	1426.62	5.1
Medicare	15	51	20,670.69	7138.84	100.0	18,813.04	6391.49	91.0	829.76	213.23	4.0	1027.89	1205.32	5.0

^aEPOCH has <5 managed care and Medicare patients.