Real-world evidence on survival, adverse events, and health care burden in Medicare patients with mantle cell lymphoma

Abstract

Most data on overall survival (OS) and adverse events (AEs) in patients with mantle cell lymphoma (MCL) are from controlled trials; therefore, in this population-based study, we retrospectively assessed treatment patterns, OS, and AEs in MCL patients initiating systemic treatment during 2013–2015 using the United States Medicare claims database. Among 1390 eligible patients (median age = 74 years), chemoimmunotherapy with bendamustine/rituximab (BR) was the preferred choice in first-line (35.3%), followed by ibrutinib (33.5%), rituximab (9.1%), and rituximab/cyclophosphamide/doxorubicin/vincristine (R-CHOP) (6.8%). Twenty-four-month OS was 73% for BR; 47%, ibrutinib; 72%, rituximab; and 71%, R-CHOP. For the four most commonly used regimens, neutropenia, anemia, hypertension, and infection were the most frequent AEs. Patients with ≥3 AEs had nearly four times higher monthly costs than those with 0–2 AEs in the first observed therapy line. Findings demonstrate a substantial increase in the economic burden as the number of AEs increased among the Medicare MCL patients.

Keywords:

• Mantle cell lymphoma
• MCL
• economic burden
• costs
• treatment patterns
• adverse events

Acknowledgements

The authors thank John Forbes and Joyce Hicks from RTI Health Solutions, who helped with editing and developing this article in accordance with the journal’s submission guidelines.

Disclosure statement

Ravi K. Goyal, Saurabh P. Nagar, Keith L. Davis, and James A. Kaye are full-time employees of RTI Health Solutions, which received funding from AstraZeneca to conduct this research. RTI Health Solutions is a business unit of Research Triangle Institute, which is an independent, nonprofit, research organization that does work for government agencies and private companies. Shaum M. Kabadi and Hannah Le are full-time employees of AstraZeneca, the funding organization for this analysis. Michael L. Wang has the following disclosures Consultancy: Janssen, AstraZeneca, More Health, Acerta Pharma, Kite Pharma, Guidepoint Global, BioInvent; Honoraria: Janssen, Pharmacyclics. AstraZeneca, Celgene, Dava Oncology; Research Funding: Janssen, Pharmacyclics, AstraZeneca, Acerta Pharma, Kit Pharma, BioInvent, VelosBio, Loxo Oncology, Celgene, Juno Therapeutics, Aviara; Speaker Bureau: Janssen, AstraZeneca and Equity Ownership: More Health. Xianglin L. Du and Preetesh Jain have nothing to disclose.

Data availability statement

The data that support the findings of this study are available through the Centers for Medicare and Medicaid Services. Restrictions apply to the availability and accessibility of these data, which were used under a data use agreement for this study.

Additional information

Funding

This study was funded by AstraZeneca, which is conducting clinical research in MCL.