Patient characteristics, healthcare resource utilization and costs across treatment lines in diffuse large B-cell lymphoma - a German claims data study.

Aim: Given the limited availability of real world diffuse large B-cell lymphoma (DLBCL) data in Germany, we assessed the baseline characteristics, treatments, clinical complications, healthcare resource utilization and costs of DLBCL across treatment lines using German claims data. Materials & methods: In a retrospective cohort study using claims data from a German sickness fund (AOK PLUS), we identified patients with an incident DLBCL diagnosis between 2012 and 2022. Using an algorithm based on German treatment guidelines, patients were stratified into first (1L), second (2L) and third line (3L) treatment. We then descriptively analyzed baseline characteristics, treatments, clinical complications, healthcare resource utilization and costs.

Results

A total of 2423 patients with DLBCL and 1L treatment were included in the study (49.1% female; mean age: 69.7 years; mean CCI: 7.0; median follow-up: 29.3 months). A total of 1209 (49.7%) and 505 (20.8%) patients progressed to 2L and 3L, respectively. A total of 209 patients received a stem cell transplant (SCT; mean age: 56.1 years); 37 received a chimeric antigen receptor T-cell therapy (CAR-T; mean age: 60.8 years). Most patients had at least one DLBCL related hospitalization during follow-up (1L: 79.2%; 2L: 60.0%; 3L: 71.9%; mean length of stay [days/patient year]: 1L: 15.2; 2L: 6.4; 3L: 14.2), with corresponding hospitalization costs of 12,777€ (1L), 5993€ (2L) and 17,408€ (3L) per patient year. Clinical complications were common, particularly in 3L, including neutropenia (1L: 31.9%; 2L: 27.0%; 3L: 46.9%), pneumonia (1L: 19.6%; 2L: 16.8%; 3L: 30.3%), anemia (1L: 17.8%; 2L: 18.7%; 3L: 35.2%), thrombocytopenia (1L: 17.3%; 2L: 21.8%; 3L: 45.1%) and sepsis (1L: 14.6%; 2L: 13.0%; 3L: 23.2%).

Conclusion

The high proportion of patients with second or later-line treatment (indicating a relapse or refractory disease), the low number of SCTs together with many clinical complications and healthcare resource use underscore the need for novel effective and well-tolerated DLBCL treatment options.