Healthcare Resource Utilization and Costs in Patients with Mantle Cell Lymphoma in the Third-Line Setting in the US

Abstract

Background: Treatment of mantle cell lymphoma (MCL) is characterized by multiple lines of therapy. Previous studies have described healthcare resource utilization (HCRU) and costs of MCL in the third-line or greater (3L+) setting, but none have estimated outcomes attributable to MCL specifically. Additionally, newer therapies have recently been added to clinical guidelines.Objective: Identify the attributable HRU and cost of MCL in the year following the initiation of third-line therapy. Methods: Retrospective cohort study using MarketScan health insurance claims data. The Merative™ MarketScan® Databases are U.S. claims datasets with de-identified medical and pharmacy claims linked to enrollment data for individuals with commercial or Medicare supplemental insurance. Incident third-line mantle cell lymphoma patients (MCL3L) were identified between April 1st, 2016, to December 31st, 2022, and followed up until loss of enrollment or one year after initiation of third-line therapy. Matched cohorts for the commercial and Medicare supplemental populations were selected using propensity scores based on age, sex, cancer-adjusted-CCI, region, commercial vs. Medicare supplemental payer type, and presence of non-heme cancer. Six-month HCRU use was evaluated in patients with at least 6 months of continuous enrollment post-index. Annual costs for all patients were calculated accounting for censoring using Kaplan-Meier Sample Average (KMSA). HRU were compared using a t-test for mean days of utilization and a chi-square test for the presence of utilization or not. Confidence intervals for costs were calculated using the bootstrap method for both cohort-specific outcomes and the difference between the two cohorts. Results: Third-line or later MCL patients had significantly greater HRU across all care settings compared to matched controls. Within six months post-index, a higher proportion of MCL patients had ≥1 inpatient admission (50.5% vs. 11.6%; p < 0.001), ≥1 emergency department (ED) visit (50.5% vs. 14.7%; p < 0.001), and ≥1 outpatient visit (100% vs. 50.5%; p < 0.001). Among those with ≥1 event, MCL patients had significantly higher ED visit counts (1.96 vs. 1.36; mean difference [MD] = 0.60, 95% CI: 0.07 to 1.13; p = 0.030) and outpatient visit counts (26.8 vs. 9.4; MD = 17.4, 95% CI: 13.33 to 21.47; p < 0.001). Mean number of inpatient admissions (1.81 vs. 1.36; MD = 0.45, 95% CI: –0.06 to 0.96; p = 0.098) and mean length of stay per admission (8.72 vs. 5.13 days; MD = 3.59, 95% CI: –0.24 to 7.42; p = 0.071) trended higher among MCL patients. Attributable annual costs were $6,302 (95% confidence interval [CI]: $4,907–$7,877) for pharmacy, $14,410 (95% CI: $7,482–$22,885) for inpatient services, $8,586 (95% CI: $6,414–$10,937) for outpatient services, and $204 (95% CI: $59–$353) for ED visits. The total attributable annual cost was $29,613 (95% CI: $21,585–$39,045). Discussion: We found the one-year attributable costs in third-line plus treatment of mantle cell lymphoma exceeded $32,000, driven primarily by inpatient and outpatient services. There were significant differences in the % healthcare resource utilization in the 6 months following index, but these results were only in the patients who had at least 6 months of continuous enrollment potentially under-representing sicker patients who disenroll early. As the treatment landscape continues to evolve, understanding these costs is essential for payers and policymakers evaluating the value of emerging therapies.