Comparison of Out-of-Pocket Costs and Quality of Life (QOL) for Patients (pts) with Hodgkin’s Disease (HD), Indolent Non-Hodgkin’s Lymphoma (INHL) and Aggressive Non-Hodgkin’s Lymphoma (ANHL).

BACKGROUND: We report preliminary results from a study on the out-of-pocket costs (cancer related costs not covered by healthcare insurance) for 57 lymphoma pts. To explore factors that influence out-of-pocket costs and QOL, cancer type, stage, time since diagnosis (Dx), treatment type (with or without rituximab), and age were evaluated.

METHODS: Lymphoma pts provided information on out-of-pocket costs for 3-month periods after lymphoma Dx and completed the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) QOL measure. Monthly costs were evaluated. Direct medical costs are costs related to medications, hospital bills, and doctor visits. Direct non-medical costs are peripheral costs related to transportation, meals, and telephone calls.

RESULTS: The majority of lymphoma pts were Caucasian (87%), married (63%), ≤ 55 years old (58%), and employed (40%). All pts were undergoing active treatment and had healthcare insurance coverage. 62% of pts had stage I-III lymphoma, 35% had stage IV, and 3% had unknown stage. Mean monthly total out-of-pocket costs for all 57 lymphoma pts were $818. Direct medical costs for HD pts were 3.2 and 1.4-fold higher than for INHL and ANHL pts, respectively. Direct non-medical costs were highest for ANHL. Total costs for pts < 6 months since Dx were 1.5 and 2.2-fold higher than for pts 6–12 and > 12 months since Dx, respectively. Total costs for pts undergoing treatment without rituximab were 1.5-fold higher than costs for pts with rituximab. Pts ≤ 55 years old had 1.4-fold higher costs than pts > 55 years old. QOL for pts < 6 months since Dx was greater than for pts ≥ 6 months since Dx (p-value =0.02).

CONCLUSION: The mean monthly out-of-pocket costs were greatest for HD ($1,136), followed by ANHL ($847) and INHL ($447), and were driven primarily by direct medical costs. Though pts < 6 months since Dx incurred higher total costs than pts ≥ 6 months since Dx, their QOL measures were better. It is important to evaluate costs and quality of life of pts with cancer when describing the economic and psychosocial burden of cancer.