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Conference Coverage

Clinical and Economic Burden of MCL in the VHA Population

September 14, 2020

An increase in costs and health care utilization was demonstrated as veteran patients with mantle cell lymphoma (MCL) progressed through multiple lines of therapy, according to a study presented at the virtual 2020 Association of VA Hematology/Oncology (AVAHO) Annual Meeting.

“MCL is an incurable B-cell non-Hodgkin lymphoma, with a predilection for those who are older, male, and Caucasian. With these epidemiologic characteristics, we wanted to better understand the impact of MCL in the US Veteran population,” explained Dr Bijal Shah, MD, Moffitt Cancer Center, Tampa, Florida, during this presentation.

This retrospective cohort analysis aimed to examine the clinical burden, costs and healthcare resource utilization of those veterans diagnosed with MCL.

Patients diagnosed with MCL who initiated treatment between 2014 and 2018 were identified in the Veteran’s Health Administration (VHA) database. Patients were included if they had continuous enrollment for 6 months prior to and >60 days following the index date, defined as the initiation of therapy.

Patients were followed through ≤3 lines of therapy. Treatment regimens were mutually exclusive and categorized as bendamustine-based, Bruton’s tyrosine kinase (BTK)-based, rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)-based, rituximab monotherapy, and other regimens.

Dr Shah and colleagues looked at treatment regimens, costs, and hospitalizations by each line of therapy.

The prevalence of MCL among the VHA population ranged from 8-11 cases and the incidence ranged from 0.6-2.6 cases per 100,000 persons, during the years studied.

A total of 390 patients were identified and received first-line therapy. Of these 146 patients were followed through the second-line setting and 47 were followed through the third-setting.

The most common first-line treatment was bendamustine-based regimen, with lower utilization in following lines of therapy. The second most common first-line treatment was BTK-based regimen, which was also the most common MCL treatment in later lines of therapy. R-CHOP-based regimens were the least commonly used in any line of therapy.

The overall treatment discontinuation rate was 82%. Approximately 38% of MCL patients had a hospitalization, with a mean length-of-stay (LOS) of 5.6 days. The hospitalization rate was 29% (mean LOS: 3.5), 36% (mean LOS: 4.4), and 26% (mean LOS: 3.1) during first-line, second-line, and third-line settings, respectively.

The per-patient-per-month costs were $19,338 overall, and $19,239, $20,064, and $27,663 respectively, during first-line, second-line, and third-line therapy, respectively.

“Bendamustine- and BTK-based regimens were the most commonly used frontline treatments for MCL patients within the VHA population. We did see as patients progressed from the frontline to second- and third-line settings an increase in costs as well as health care utilization,” Dr Shah concluded.—Janelle Bradley

Shah B, Yang K, Keriburyo F, et al. Clinical and Economic Burden of Mantle Cell Lymphoma in the Veteran Health Administration Population. Presented at: the Virtual 2020 AVAHO Annual Meeting; Sept 12-13, 2020. Abstract 16.

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