Real-World Treatment Patterns, Survival, Health Resource use and Costs Among Medicare Beneficiaries with Diffuse Large B-Cell Lymphoma

Figures & data

Table 1. Characteristics of treated elderly Medicare beneficiaries with newly diagnosed diffuse large B-cell lymphoma between 1 October 2015 and 31 December 2018 by line of treatment received.

Characteristics	Front-line		Relapsed/refractory
	1L+		2L+		3L+		4L+
	N	%	N	%	N	%	N	%
N	11,880	100	2116	100	466	100	110	100
Length of available follow-up in years from initial DLBCL diagnosis (median)	2.1		1.9		2.1		2.3
Length of available follow-up in years from initiation of specific line of treatment (median)	1.9		0.9		0.6		0.4
Age, median (IQR)	76.0 (71.0, 81.0)		75.0 (71.0, 80.0)		75.0 (71.0, 80.0)		74.0 (70.0, 78.0)
65–69	1968	16.6	360	17.0	88	18.9	24	21.8
70–74	3214	27.1	585	27.6	135	29.0	33	30.0
75–79	2939	24.7	546	25.8	126	27.0	31	28.2
80+	3759	31.6	625	29.5	117	25.1	22	20.0
Sex
Male	6051	50.9	1145	54.1	266	57.1	62	56.4
Female	5829	49.1	971	45.9	200	42.9	48	43.6
Race
White	10,694	90.0	1875	88.6	399	85.6	91	82.7
Non-white	1186	10.0	241	11.4	67	14.4	19	17.3
Census Region
Northeast	2470	20.8	447	21.1	88	18.9	23	20.9
Midwest	3040	25.6	515	24.3	114	24.5	20	18.2
South	4293	36.1	747	35.3	164	35.2	39	35.5
West	2077	17.5	407	19.2	100	21.5	28	25.5
Metropolitan Status
Urban	9418	79.3	1707	80.7	369	79.2	89	80.9
Rural	2462	20.7	409	19.3	97	20.8	21	19.1
Part D Low-Income Subsidy (LIS) Status
LIS	1643	13.8	291	13.8	62	13.3	13	11.8
Non-LIS	10,237	86.2	1825	86.2	404	86.7	97	88.2
NCI-adjusted Charlson comorbidity score, mean (SD)	1.2 (1.5)		1.1 (1.5)		1.0 (1.3)		1.0 (1.3)
All-cause hospitalization in 12-months prior to initial DLBCL diagnosis	3498	29.4	597	28.2	119	25.5	31	28.2
All-cause total healthcare costs in 12-months prior to initial DLBCL diagnosis, US$	$21,791 ($28,827)		$22,440 ($32,348)		$20,547 ($23,897)		$21,246 ($23,075)
Index year of DLBCL diagnosis
2015	1208	10.2	258	12.2	71	15.2	17	15.5
2016	3713	31.3	706	33.4	180	38.6	43	39.1
2017	3749	31.6	645	30.5	119	25.5	28	25.5
2018	3210	27.0	507	24.0	96	20.6	22	20.0

DLBCL: Diffuse large B-cell lymphoma; IQR: Interqautile range; NCI: National Cancer Institute; SD: Standard deviation.

Table 2. Treatment patterns among Medicare beneficiaries with diagnosed diffuse large B-cell lymphoma by line of treatment.

Treatment patterns	Front-line	Relapsed/refractory
	1L+ (N = 11,880)	2L+ (N = 2116)	3L+ (N = 466)	4L+ (N = 110)
	%	%	%	%
Time and duration of treatment
Time from diagnosis to treatment, months
Median (IQR)	1.1 (0.7, 1.6)	7.8 (4.2, 15.1)	15.3 (9.9, 23.7)	19.1 (14.7, 27.6)
Duration of treatment, days
Median (IQR)	122.0 (74.0, 141.0)	78.0 (50.0, 118.0)	62.5 (33.0, 113.0)	61.5 (32.0, 93.0)
Time between treatments, days^†
Median (IQR)	NA	51.0 (1.0, 228.5)	35.5 (1.0, 150.0)	12.5 (1.0, 101.0)
Type of Treatment Received within the Specific Line of Treatment (%)
CHOP-based Regimen (+/- steroid)	69.8	21.1	7.3	<10^‡
CVP-based Regimen (+/- steroid)	7.1	7.7	6.0	<10^‡
Bendamustine-based Regimen (+/- steroid)	6.2	20.3	20.8	13.6
Gemcitabine-based Regimen (+/- steroid)	1.6	18.2	20.2	19.1
BTKi-based regimen (+/- steroid)	<0.1^‡	0.7	<2.4^‡	<10^‡
Lenalidomide-based Regimen (+/- steroid)	0.2	1.7	3.4	<10^‡
CD20 Monotherapy (+/- steroid)^§	8.9	NA	NA	NA
Ifosfamide-based Regimen (+/- steroid)	0.3	3.8	3.0	<10^‡
Cytarabine-based Regimen (+/- steroid)	0.8	3.3	3.9	<10^‡
Other Regimens (+/- steroid)	>5.1^‡	23.2	>33.0^‡	46.4

† Time reported under each column is the time from the end of a previous treatment to the start of the line of treatment.

‡ Exact value cannot be reported per CMS policy because it would allow calculation of a cell size <11 patients.

§ Due to the nature of our lines of therapy algorithm, CD20 monotherapy could only be assessed in the front-line setting.

Each column may include patients who have progressed to other lines of therapy, but the results will be reported as specific to the line of treatment in the column header.

DLBCL: Diffuse large B-cell lymphoma; IQR: Interquartile range; NA: Not applicable.

Figure 1. Overall survival rates from initiation of each line of treatment among Medicare beneficiaries with diagnosed diffuse large B-cell lymphoma.

OS: Overall survival.

Table 3. Healthcare resource utilization among treated Medicare beneficiaries with diffuse large B-cell lymphoma in the 12-months after initiation of the specific line of treatment.

Healthcare resource utilization	Frontline^†	Relapsed/refractory^†
	1L+ (N = 11,619)	2L+ (N = 1763)	3L+ (N = 335)	4L+ (N = 75)
	%	%	%	%
All-cause healthcare resource utilization
Hospitalizations
Any hospitalization (%)	56.9	64.6	71.9	81.3
Number of hospitalizations, mean among those who had a hospitalization)	2.5	2.3	2.1	2.0
Length of stay per hospitalization, mean	6.9	8.3	8.7	8.2
Skilled nursing facility stays
Any stay (%)	15.1	15.0	17.0	25.3
Number of stays, mean (among those who had a SNF stay)	2.5	2.2	2.0	2.3
Hospice care (%)	13.3	31.8	44.5	58.7
Home health visits
Any visits (%)	35.3	36.4	39.1	30.7
Number of visits, mean (among those who had a home health visit)	1.9	1.8	1.6	1.3
Physician visits (evaluation/management visits)
Any visits (%)	>99^§	98.0	96.1	>85^§
Number of visits, mean (among those who had a physician visit)	19.3	17.2	16.0	12.2
Diffuse large B-cell lymphoma-related healthcare resource utilization ^‡
Hospitalizations
Any hospitalization (%)	40.2	46.6	49.9	54.7
Number of hospitalizations, mean (among those who had a hospitalization)	2.2	1.9	1.9	1.6
Length of stay per hospitalization, mean	7.3	9.0	9.4	8.8
Skilled nursing facility stays
Any stay (%)	5.8	5.7	6.0	<15^§
Number of stays, mean (among those who had a SNF stay)	2.2	1.9	1.7	1.7
Hospice care (%)	6.6	17.1	24.5	26.7
Home health visits
Any visits (%)	17.8	19.1	20.9	<15^§
Number of visits, mean (among those who had a home health visit)	1.7	1.5	1.3	1.4
Physician visits (evaluation/management visits)
Any visits (%)	88.5	83.6	79.1	77.3
Number of visits, mean (among those who had a physician visit)	10.2	9.6	9.5	7.8

† In order to assess healthcare resource use in the 12-months after initiation of a given line of therapy, an additional requirement of continuous eligibility for 12 months (or until death if it occurred earlier) after the initiation of a given line of therapy was applied, which led to a very small reduction in the Ns across the frontline and relapsed/refractory settings.

‡ DLBCL-related HRU was identified based on medical claims with a diagnosis of DLBCL in any position.

§ Exact value cannot be reported per CMS policy because it would allow calculation of a cell size <11 patients.

DLBCL: Diffuse large B-cell lymphoma; HRU: Healthcare resource use; SNF: Skilled nursing facility.

Figure 2. All-cause and diffuse large B-cell lymphoma-related total healthcare costs among Medicare beneficiaries with diagnosed diffuse large B-cell lymphoma in the 12 months after initiation of the specific line of treatment.

DLBCL: Diffuse large B-cell lymphoma.

Figure 3. Diffuse large B-cell lymphoma-related medical and prescription drug costs among Medicare beneficiaries with diagnosed diffuse large B-cell lymphoma in the 12 months after initiation of the specific line of treatment.

DLBCL: Diffuse large B-cell lymphoma.