A Systematic Review of The Health-Related Quality of Life and Costs in Diffuse Large B-Cell Lymphoma

OBJECTIVES: As survival outcomes improve for patients with diffuse large B-cell lymphoma (DLBCL), it is increasingly important to understand costs and humanistic burden to evaluate the need for new treatments. We conducted systematic reviews to understand the health-related quality of life (HRQoL) of patients with DLBCL and costs associated with treatment. METHODS: MEDLINE, EMBASE, EconLit, UK National Health Service Economic Evaluation Database, andTlifts University Cost-Effectiveness Analysis Registry were searched for studies published between 2000-2016. Trial registries and health technology assessment websites were searched for appraisals with relevant economic and HRQoL data; abstracts were identified from ASCO, ESMO, ASH, EHA, and ISPOR. RESULTS: After screening, 25 of 2184 references were included for HRQoL; 20 of 1481 references were included for costs. Ten studies used the EORTC QLQ-C30. The EQ-5D and FACT-Lym are used in trials with unpublished data. Patients who achieve complete response after first-line treatment have significantly greater improvements on HRQoL compared to non-complete responders (p=0.05). Symptoms that compromise HRQoL persist for up to 5 years for patients that do not respond to first-line treatment. Economic studies focused on cost of treatment and hospitalization, with few studies reporting societal costs. Cost-effectiveness analyses in the UK, France, US and Canada concluded that R-CHOP is a cost-effective first-line treatment compared to CHOP; R- CHOP was not found to be cost effective in a Chinese study. Second-line treatment results in additional costs, with autologous stem cell transplantation and hospitalization being most costly. Stratification of treatment according to DLBCL subtype (GCB vs ABC) has been shown to be cost-effective. CONCLUSIONS: Novel, targeted DLBCL first-line treatments have the potential to provide a more cost-effective, manageably budgeted treatment paradigm, reduce disease progression, and improve HRQoL. Although DLBCL subgroups are recognized in clinical guidelines, further studies are needed to understand their specific HRQoL and economic burden.