Cost and Healthcare Utilization in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: A Real-World Analysis of Medicare Beneficiaries Receiving Chimeric Antigen Receptor T-Cell Vs. Autologous and Allogeneic Hematopoietic Cell Transplants

Introduction: Patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) can be treated with 3 resource intense options: autologous hematopoietic cell transplant (Auto-HCT), allogeneic HCT (Allo-HCT), or autologous anti-CD19 chimeric antigen receptor T-Cell (CAR T) therapy after two or more lines of systemic therapy, depending on the clinical scenario. Our aim was a comparative analysis of healthcare resource utilization (HCRU) and associated costs for matched samples of Medicare patients for treatment planners, payers, and policy-makers. Methods: This study utilized a retrospective, observational cohort design. Data were derived from the Center for Medicare and Medicaid Services (CMS) 100% Medicare Fee-for-Service (FFS) Part A and B claims data. Part D data for the study period were not yet available, so pharmacy claims for oral medications were not evaluated. Patients with DLBCL were included if they received CAR T or Auto-HCT between 10/1/2017 and 3/31/2019 or Allo-HCT between 7/1/2012 and 3/31/2019. Patients with more than 1 CAR T or HCT were excluded. The index date was the date of initiation of the procedure. To allow for evaluation of patient characteristics and treatments pre- and post-procedure, patients must have been continuously enrolled in Medicare FFS for 6 months prior to (PRE) and after (POST) the index date. Patients who died during the POST period were included. The 3 cohorts CAR T, Auto-HCT, and Allo-HCT were matched on baseline clinical characteristics using 1:1 propensity score matching with a caliper of 0.05, with Auto-HCT and Allo-HCT patients assumed to be clinically distinct populations offered at different lines of therapy and so were matched to CAR T patients separately. Due to limitations of the data, we were not able to match patients by line of therapy. Baseline characteristics were age, gender, race, census region, dual eligibility status (i.e. Medicare plus Medicaid), ECOG-PS (derived from claims using a validated, published method), Charlson-Deyo Comorbidity Index (CCI) and recent history of DVT/PE or cytopenias. Measures of HCRU were all-cause hospitalizations, outpatient, and emergency department (ED) visits. Costs were total paid amounts. HCRU and cost data were calculated for the 6 months PRE and POST, but do not include the utilization and costs associated with the index procedure itself. Results: The CAR T/Auto-HCT analysis included 175 patients each, while the CAR T/Allo-HCT analysis included 142 pati