Follicular NHL (f-NHL) accounts for approximately 70% of indolent lymphomas. We estimated the marginal cost of progression for patients with f-NHL treated in the outpatient community setting.
Using US Oncology's iKnowMed electronic medical records (EMR), we identified 1002 f-NHL patients who achieved complete remission or had documented stable disease between 7/1/2006 and 2/29/2008. This database captures information in a network of about 1,200 community-based oncologists where patients are treated according to usual clinical practice with no criteria for therapy selection and no schedule of visits imposed. To estimate outpatient cost of care, we linked the EMR data to US Oncology's claims data warehouse. Patients were categorized into 2 cohorts based on whether they experienced disease progression or not. Patient demographic and clinical information were characterized at baseline and follow-up time was censored at the last entry for disease status or 6 months after date of complete remission/ stable disease or date of progression. Costs per patient month (estimated based on outpatient claims and normalized to 2007 Medicare reimbursement rates) were compared between progressed and non-progressed patients. Econometric regression analysis was used to compare healthcare cost after adjusting for potential confounders. To further explore the economic burden of progression, we compared resource utilization as measured by outpatient physician visits, chemotherapy visits, laboratory and acute care visits.
Of the 1,002 f-NHL patients identified, 204 progressed and 798 did not. At baseline, patients who progressed were more likely to have been diagnosed with advanced disease, have 4+ positive lymph nodes, have worse ECOG performance status and high LDH and low HGB levels compared to patients who did not progress. The mean overall costs per patient-month over the 6-month follow-up period were significantly higher for patients who progressed vs. those who did not progress ($3612 vs. $965; difference = $2,647; p<0.001), with a relative cost nearly 4 times higher. After adjusting for differences in clinical factors (HGB levels, lymph nodes, ECOG performance status), disease progression was associated with a 2-fold increased cost (p<0.001). Patients who progressed had significantly higher frequencies of outpatient physician visits and laboratory procedures compared to patients without progression and were significantly more likely to receive chemotherapy and be admitted to the hospital and/or ER.
Results of this retrospective study indicate that therapies which delay disease progression for f-NHL may provide substantial economic benefits in addition to improvements in clinical outcomes.
Hoang:Genentech: Consultancy. Gruschkus:US Oncology: Employment. Darragh:US Oncology: Employment. Forsyth:US Oncology: Employment. Beveridge:US Oncology: Consultancy, Employment. Reyes:Genentech Inc: Employment.
Asterisk with author names denotes non-ASH members.