Hospital based costs associated with novel treatments and traditional B-Cell regimens in peripheral t-cell lymphoma (PTCL) patients

Background: PTCL is a difficult to treat, heterogeneous form of non-Hodgkins Lymphoma. Traditional B-cell lymphoma regimens (tBCLr) have been adapted for use in PTCL but have shown low response rates and short duration of response. Novel therapies (NT) for PTCL are available, but it is unclear how much additional costs are associated with these agents. Study objectives were to compare the treatment patterns and costs associated with NT and tBCLr in PTCL patients. Methods: A retrospective analysis examined PTCL patients who received both a NT (pralatrexate, romidepsin, brentuximab) and tBCLr (CHOP, ICE, EPOCH, etc.) using MedAsset data, a hospital administrative claims dataset covering inpatient/outpatient services. Costs were collected when patients were considered to be on therapy and standardized into cost/day. Between group differences were tested using analysis of variance and multivariable general linear regression with gamma distribution. Results: We identified 169 patients treated with NT (n = 189) and tBCLr (n = 176) across lines of therapy. Most NT regimens (79% vs 50%) were given to relapse patients and for longer median duration of therapy (DOT) (63 vs 23.5 days p < 0.05). tBCLr patients had higher mean total costs per day of therapy compared to NT [$1,834 (SD: 4,427) vs $1,055 (SD: 1,011) p < 0.05]. While on tBCLr, patients had higher mean numbers of inpatient admissions (1.02 vs 0.49 p < 0.05) and longer inpatient length of stay (8.8 vs 4.1 days p < 0.05). In a regression analysis, tBCLr regimens had an estimated 30% higher daily costs of $368 (IRR = 1.30 p < 0.05) and a 53% decreased DOT (IRR = 0.53 p < 0.05) after controlling for differences in patient groups. Conclusions: Results show that patients have longer DOT and lower per day costs when treated with NT compared to tBCLr, likely driven by fewer admissions and shorter length of stay. This analysis is limited in scope since patients treated by community oncologists not affiliated with hospitals are not considered. However, the results indicate that while NT have higher upfront drugs costs, they have the benefit of a longer time on treatment while the total daily cost of therapy appears comparable and possibly in favor of NT.