Treatment, mortality, and health care costs in a U.S. cohort of indolent non-Hodgkin lymphoma patients with relapsed or refractory disease.

35 Background: Indolent non-Hodgkin lymphomas (iNHL) have relapsing courses after initial therapy. For those who relapse, the response duration to subsequent lines of therapy shortens with time, eventually becoming refractory. Using a large national claims database, this study examined the treatment, mortality and healthcare costs of iNHL patients who relapse after initial therapy.Patients newly diagnosed with iNHL (i.e., follicular lymphoma, small lymphocytic lymphoma, marginal zone lymphoma, lymphoplasmacytic lymphoma) during 2004-2013 were identified from the Truven Health MarketScan Commercial and Medicare claims databases. Relapsed or refractory disease (R/R) was defined as those patients relapsing/not responding within 6 months on any combination of alkylating agents (AA) and rituximab (R) as evidenced by having claims indicating a change in treatment. Patients were followed from the start of the new treatment (index date) until death or end of data. Healthcare costs were adjusted to 2013 dollars.Among a total of 254,067 iNHL patients, 1,483 (1.4%) met study criteria for R/R. The average age was 63 (SD 13) and 61% were male. Common comorbidities were: lipometabolic disorders (44%), hypertension (40%), diabetes mellitus (17%), chronic pulmonary disease (15%), cerebrovascular disease (7%) and renal disease (6%). The most common first line regimens were rituximab, cyclophosphamide, doxorubicin and vincristine ± prednisone/ dexamethasone (22%). The mean duration of first-line and second-line therapy was 230 (SD 401) and 369 (SD 544) days, respectively. Among the 45% patients with mortality information, the median survival time from R/R was 5.3 months (mean 16.4, SD 17.7). During the follow up period from the initial date of R/R, the mean annual total medical cost was $170,179 (SD $250,376): 62% outpatient, 34% inpatient and 4% outpatient pharmacy.Patients with R/R iNHL represented a relatively small fraction of all iNHL patients, but had high mortality rate and incurred substantial medical cost.