Treatment patterns, healthcare resource utilization, and costs of patients diagnosed with primary mediastinal B-cell lymphoma in the United States

Figures & data

Figure 1. Patient disposition. Abbreviations. DLBCL, diffuse large B-cell lymphoma; ICD-9-CM, International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Revision; PMBCL, primary mediastinal large B-cell lymphoma; US, United States. 1. PMBCL can only be identified using ICD-10-CM codes, which are available since October 1, 2015, in the US.

Table 1. Baseline Demographic and Clinical Characteristics for Patients with PMBCL.

Characteristics	Incident patients	Prevalent patients
	N = 118	N = 30
Observation period, days, mean ± SD [median] (IQR)	405.8 ± 252.3 [376] (194, 612)	907.9 ± 257.3 [963] (732, 1,063)
Demographics^a
Age, years, mean ± SD [median]	59.5 ± 19.8 [66]	60.0 ± 20.2 [66]
Gender, female, n (%)	70 (59.3)	18 (60.0)
Year of index date^a, n (%)
2014	0 (0.0)	8 (26.7)
2015	15 (12.7)	22 (73.3)
2016	51 (43.2)	0 (0.0)
2017	44 (37.3)	0 (0.0)
2018	8 (6.8)	0 (0.0)
Region^a, n (%)
South	46 (39.0)	9 (30.0)
West	26 (22.0)	8 (26.7)
Midwest	25 (21.2)	7 (23.3)
Northeast	21 (17.8)	6 (20.0)
Insurance plan type^a, n (%)
Commercial insurance	56 (47.5)	14 (46.7)
Medicare	62 (52.5)	16 (53.3)
CCI^2, mean ± SD [median]	2.2 ± 2.7 [1]	1.7 ± 1.9 [2]
Comorbidities (nonpsychiatric)^b,c, n (%)
Hypertension	58 (49.2)	18 (60.0)
Chronic pulmonary disease	33 (28.0)	7 (23.3)
Diabetes	29 (24.6)	7 (23.3)
Cardiac arrhythmias	28 (23.7)	6 (20.0)
Hypothyroidism	28 (23.7)	6 (20.0)
Comorbidities (psychiatric)^b,d, n (%)
Sleep-wake disorders	25 (21.2)	3 (10.0)
Substance-related and addictive disorders	18 (15.3)	1 (3.3)
Anxiety disorders	17 (14.4)	1 (3.3)
Depressive disorders	16 (13.6)	5 (16.7)
Other conditions that may require a focus of clinical attention	16 (13.6)	4 (13.3)
All-cause HRU^b, mean ± SD [median]
IP stays	0.31 ± 0.69 [0]	0.17 ± 0.46 [0]
ER visits	1.4 ± 3.0 [0]	1.3 ± 1.9 [1]
OP visits	15.2 ± 15.3 [11]	15.7 ± 16.2 [14]
Other visits	3.9 ± 7.5 [0]	1.8 ± 3.7 [0]
All-cause healthcare costs^b, US$ 2018, mean ± SD [median]
Total costs (medical + OP pharmacy)	$22,925 ± 30,363 [12,442]	$22,538 ± 37,262 [8,652]
Total medical costs	$20,646 ± 28,770 [10,697]	$21,138 ± 36,126 [7,636]
IP costs	$6,642 ± 19,482 [0]	$2,734 ± 7,654 [0]
ER costs	$4,343 ± 11,385 [0]	$4,549 ± 7,252 [705]
OP costs	$8,148 ± 9,877 [4,180]	$12,801 ± 32,108 [3,458]
Other costs	$1,513 ± 5,230 [0]	$1,054 ± 3,310 [0]
OP pharmacy costs	$2,279 ± 4,995 [480]	$1,400 ± 2,170 [552]

Abbreviations. CCI, Charlson comorbidity index; DSM-V, Diagnostic and Statistical Manual of Mental Disorders, 5^th edition; ER, emergency room; HRU, healthcare resource utilization; IP, inpatient; OP, outpatient; PMBCL, primary mediastinal B-cell lymphoma; SD, standard deviation; US, United States.

^a Evaluated at the index date.

^b Evaluated during the 12 months prior to the index date.

^c Most prevalent among the Elixhauser comorbidities.

^d Most prevalent among the DSM-V comorbidities.

Figure 2. Most Frequent Treatments during the Observation Period for Patients with Incident (a) and Prevalent (b) PMBCL. Abbreviations. BR, bendamustine plus rituximab; EPOCH-R, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin, plus rituximab; FOLFOX, fluorouracil, leucovorin, and oxaliplatin; Ib + R, ibrutinib plus rituximab; PMBCL, primary mediastinal B-cell lymphoma; R-CEOP, rituximab plus cyclophosphamide, etoposide, vincristine, and prednisone; R-CHOP, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone; R-CVP, rituximab plus cyclophosphamide, vincristine, and prednisone; R-GemOx, rituximab plus gemcitabine and oxaliplatin; 1L, first line; 2L, second line; 3L, third line.

Table 2. Treatment patterns during the observation period for patients with PMBCL.

Treatment patterns	Patients with at least
	1L therapy	2L therapy	3L therapy
Incident patients (N = 118)
Number of patients observed, n (%)	57 (48.3)	17 (14.4)	5 (4.2)
Observation period,^adays, mean ± SD [median] (IQR)	417.3 ± 252.7 [373] (188, 646)	399.1 ± 260.2 [335] (198, 471)	404.2 ± 270.6 [331] (212, 420)
DOT^b, days, mean ± SD	86.0 ± 69.8	62.7 ± 69.5	45.6 ± 30.1
Time from index date to 1 L initiation, days, mean ± SD	47.6 ± 61.7	NA	NA
Patients with an observed next line of therapy, n (%)	17 (29.8)	5 (29.4)	1 (20.0)
Prevalent patients (N = 30)
Number of patients observed, n (%)	19 (63.3)	6 (20.0)	NA
Observation period,^adays, mean ± SD [median] (IQR)	932.4 ± 262.9 [964] (854, 1,076)	1,070.7 ± 227.5 [1,057] (959, 1273)	NA
DOT^b, days, mean ± SD	88.3 ± 44.6	142.5 ± 67.1	NA
Time from index date to 1 L initiation, days, mean ± SD	76.3 ± 192.6	NA	NA
Patients with an observed next line of therapy, n (%)	6 (31.6)	0 (0.0)	NA

Abbreviations. DOT, duration of treatment; IQR, interquartile range; NA, not available; PMBCL, primary mediastinal large B-cell lymphoma; SD, standard deviation; 1 L, first line; 2 L, second line; 3 L, third line.

^a The observation period spans from the index date up to the end of data availability, death, or end of insurance coverage.

^b DOT was defined as the number of days from the date of initiation of a new anti-cancer treatment up to the discontinuation of all agents in the line of therapy, a switch to another line, the addition of a new agent to the current line, or the end of the eligibility period. Patients who reached the end of eligibility were included until the end of insurance enrollment.

Table 3. HRU during the evaluation period for patients with PMBCL treated with ≥1 L therapy.

	Incident patients	Prevalent patients
	N = 57	N = 19
Up to end of evaluation period
Evaluation period^a, days, mean ± SD [median]	369.7 ± 246.1 [330]	856.1 ± 282.3 [927]
All-cause HRU, PPPY, mean ± SD [median]
IP stays	1.6 ± 2.1 [1]	1.1 ± 2.2 [1]
Length of stay, days	8.3 ± 9.4 [6]	7.5 ± 4.3 [6]
ER visits	1.8 ± 3.2 [1]	1.3 ± 2.0 [1]
OP visits	45.5 ± 36.7 [46]	42.1 ± 37.2 [34]
Other visits	14.0 ± 18.1 [4]	6.2 ± 16.7 [2]
Up to 12 months
Evaluation period^b, days, mean ± SD [median]	264.7 ± 120.6 [330]	299.7 ± 110.2 [365]
All-cause HRU, PPPY, mean ± SD [median]
IP stays	1.5 ± 2.1 [1]	2.2 ± 2.5 [2]
Length of stay, days	7.1 ± 7.4 [6]	6.4 ± 6.0 [5]
ER visits	1.6 ± 2.1 [0]	1.6 ± 1.8 [1]
OP visits	52.2 ± 36.0 [58]	67.8 ± 25.5 [68]
Other visits	18.4 ± 21.7 [5]	11.8 ± 29.7 [0]

Abbreviations. ER, emergency room; HRU, healthcare resource utilization; IP, inpatient; OP, outpatient; PMBCL, primary mediastinal large B-cell lymphoma; PPPY, per-patient-per-year; SD, standard deviation; 1 L, first line.

^aThe evaluation period spans from the 1 L treatment initiation date up to the earliest of end of data availability, death, or end of insurance coverage.

^bThe evaluation period spans from the 1 L treatment initiation date up to the earliest of 12 months, end of data availability, death, or end of insurance coverage.

Table 4. Healthcare costs during the evaluation period for patients with PMBCL treated with ≥1 L therapy.

All-cause healthcare costs (US $2018)	Incident patients	Prevalent patients
	N = 57	N = 19
Up to the end of evaluation period
Evaluation period^a, days, mean ± SD [median]	369.7 ± 246.1 [330]	856.1 ± 282.3 [927]
All-cause healthcare costs, PPPY, mean ± SD [median]
Total costs	$149,340 ± 115,975 [113,411]	$92,799 ± 67,856 [71,988]
Total medical costs	$143,182 ± 113,821 [109,083]	$89,009 ± 62,298 [69,886]
IP costs^b	$30,833 ± 47,245 [12,251]	$20,472 ± 25,557 [14,531]
ER costs	$7,310 ± 16,096 [382]	$3,710 ± 4,112 [3,047]
OP costs	$90,329 ± 86,223 [78,463]	$59,946 ± 47,809 [45,720]
With drug administration	$65,327 ± 76,496 [50,427]	$46,096 ± 41,516 [33,223]
Without drug administration	$25,001 ± 39,960 [12,892]	$13,850 ± 10,434 [14,364]
Other costs^c	$14,710 ± 26,493 [948]	$4,881 ± 15,072 [91]
Pharmacy costs	$6,159 ± 14,925 [1,328]	$3,790 ± 8,327 [868]
Up to 12 months
Evaluation period^d, days, mean ± SD [median]	264.7 ± 120.6 [330]	299.7 ± 110.2 [365]
All-cause healthcare costs, PPPY, mean ± SD [median]
Total costs	$187,241 ± 122,144 [165,963]	$167,553 ± 74,771 [150,335]
Total medical costs	$179,681 ± 120,464 [162,234]	$159,660 ± 68,177 [146,764]
IP costs^b	$32,254 ± 52,326 [16,587]	$34,548 ± 38,093 [37,544]
ER costs	$8,697 ± 20,738 [0]	$4,755 ± 5,106 [4,228]
OP costs	$119,390 ± 96,459 [103,290]	$110,277 ± 51,975 [101,091]
With drug administration	$86,404 ± 85,125 [78,923]	$86,288 ± 47,035 [77,209]
Without drug administration	$32,986 ± 51,908 [16,717]	$23,989 ± 17,468 [19,126]
Other costs^c	$19,340 ± 39,440 [964]	$10,081 ± 35,752 [0]
Pharmacy costs	$7,560 ± 19,715 [1,331]	$7,893 ± 14,603 [1,967]

Abbreviations. ER, emergency room; IP, inpatient; OP, outpatient; PMBCL, primary mediastinal large B-cell lymphoma; R-CHOP, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone; 1 L, first line.

^a The evaluation period spans from the 1 L treatment initiation date up to the earliest of end of data availability, death, or end of insurance coverage.

^b Includes hospitalizations, and skilled nursing and long-term care facilities.

^c Includes visits such as home services and hospice.

^d The evaluation period spans from the 1 L treatment initiation date up to the earliest of 12 months, end of data availability, death, or end of insurance coverage.