Cost burden of diffuse large B-cell lymphoma

ABSTRACT

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma and is a clinically heterogeneous disease. Treatment pathways for DLBCL are diverse and integrate established and novel therapies.

Areas covered: We review the cost burden of DLBCL and the cost-effectiveness of DLBCL management including precision and cellular medicine. We utilized Medical Subject Heading (MeSH) terms and keywords to search the National Library of Medicine online MEDLINE database (PubMed) for articles related to cost, cost burden, and cost-of-illness of DLBCL and cost-effectiveness of DLBCL management strategies published in English as of June 2019.

Expert commentary: Available and developing DLBCL therapies offer improved outcomes and often curative treatment at considerable financial expense, and the total cost burden for DLBCL management is substantial for patients and the healthcare system. In the era of personalized medicine, CAR T cells and targeted therapies provide exciting avenues for current and future DLBCL care and can further increase treatment cost. Determinations of cost and cost-effectiveness in DLBCL treatment pathways should continue to guide care providers and systems in identifying cost reduction strategies to provide appropriate therapies to the greatest number of patients in treating DLBCL.

KEYWORDS:

• B-cell lymphoma
• cost
• cost-effectiveness
• diffuse large B-cell lymphoma
• DLBCL
• NHL
• non-Hodgkin lymphoma

Article highlights

• The total cost burden of DLBCL is substantial for patients and the healthcare system.

• Cost and cost-effectiveness analysis of novel precision therapies will be an essential component of their eventual clinical integration.

• Treatment for relapsed and refractory DLBCL adds considerable expense through costly interventions such as hematopoietic cell transplant and chimeric antigen receptor (CAR) T-cell therapy.

• Early CAR T-cell therapy cost-effectiveness evaluations indicate potential for cost-effectiveness despite high drug costs. Long-term follow-up data regarding the duration of durable response is required for robust estimates, and additional financial challenges remain.

• Routine surveillance imaging adds significant cost with no demonstrated survival benefit and is not a cost-effective form of long-term surveillance.

Declaration of interest

RA Harkins discloses that this work was supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR002378 and TL1TR002382. CR Flowers discloses that this work was supported in part by the National Cancer Institution award K24CA208132. Dr. Flowers reports consulting from Abbvie, Bayer, Celgene (unpaid), Denovo Biopharma, Genentech/Roche (unpaid), Gilead, OptumRx, Karyopharm, Pharmacyclics/Janssen, Spectrum. Dr. Flowers reports research funding from Abbvie, Acerta, Celgene, Gilead, Genentech/Roche, Janssen Pharmaceutical, Millennium/Takeda, Pharmacyclics, TG Therapeutics, Burroughs Wellcome Fund, Eastern Cooperative Oncology Group, National Cancer Institute, V Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported in part by The National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR002378, TL1TR002382 to RA Harkins, and by National Cancer Institution award K24CA208132 to CR Flowers. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.