Cost Consideration of Second Line Therapy for Relapsed Diffuse Large Lymphoma in the Community Setting

Cost consideration of second line therapy for relapsed diffuse large lymphoma in the community setting

Introduction

Despite treatment with curative intent chemotherapy, many patient with diffuse large B cell lymphoma (DLBCL) will relapse. Post relapse, the majority of patients will remain sensitive to cytotoxic chemotherapy. Commonly used regiments in this situation include Rituximab plus a combination of other agents such as

• ifosfamide, carboplatin, etoposide (R-ICE)

• etoposide, methylprednisolone, cytarabine, cisplatin (R-ESHAP)

• dexamethasone, high-dose cytarabine, cisplatin (R-DHAP)

• gemcitabine, oxaliplatin (R-Gem/Ox)

• lenalidomide (R squared)

• bendamustine (R-Bendamustine

As few clinical trials exist that compare these different regimens head to head, the decision is often left to the treating physician. We opted to look at cost as a consideration.

Methods:

For the regimens listed above, we calculated drug costs using the average wholesale price. For regimens that require inpatient hospital stays, we used historical data for cost of average hospital stay from Beckers Hospital review. A body surface area of 1.75 was used for each regimen. We determined the cost for four cycles of the different regimens. Growth factor support was included as many of these regimens require this. As our focus was on our own community institution, and is it isn't yet widely available, CAR-T was not included.

Results:

In table

Conclusions:

While a number of decisions will factor into the use of one of these regimens, cost is an important factor. Based on the above information, there is a wide range of cost. This can be one factor in deciding which combination to use. Few clinical trials have compared these regimens in a head to head fashion. One trial that did compared R-ICE to R-DHAP and essentially showed only minor outcome differences between them. In such situations, cost as well as inpatient vs outpatient hospital stays, patient preference, physician comfort with the different regimens will all play a role in determining which regimen to use.

Table.

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Table.

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