Significant clinical and economic burden remain among patients with Waldenström Macroglobulinemia (WM) in the US Veterans Health Administration (VHA) population, according to a study presented at the virtual 2020 Association of VA Hematology/Oncology (AVAHO) Annual Meeting.
“WM is a rare, incurable non-Hodgkin Lymphoma. There is limited real-world evidence on WM treatment among US Veterans,” explained Jorge Castillo, Dana-Farber Cancer Institute, Boston, Massachusetts, and colleagues, who conducted this retrospective observational study evaluating real-world treatment patterns and associated outcomes among VHA patients with WM.
Dr Costillo and colleagues identified adult patients in the VHA database who had ≥2 visits with WM diagnosis codes and ≥1 WM treatment between 2014 and 2018. The index date was defined as the first date of WM treatment.
Patients were included in the analysis if they were newly diagnosed, initiating treatment, and enrolled continuously for 6 months prior to and ≥60 days following the index date. The treatment regimens were categorized as rituximab monotherapy, ibrutinib-based, chemotherapy-based, proteasome inhibitor-based and other regimens
Healthcare resource utilization examined included hospitalization and length-of-stay (LOS). Total costs were calculated as the sum of inpatient, outpatient, and pharmacy costs per patient per month (PPPM).
The prevalence of WM in the VHA population ranged from 11.4-12.8 cases and the incidence ranged from 0.4-1.6 cases per 100,000 persons.
A total of 255 patients received first-line therapy for WM; 96 (38%) received second-line therapy; and 34 (13%) received third-line therapy. The treatment pattern for each line of therapy were, first-line: ibrutinib-based (30%), chemotherapy-based (25%), rituximab monotherapy (25%), proteasome inhibitor-based (14%), and other(5%); second-line: chemotherapy-based (27%), ibrutinib-based (24%), rituximab monotherapy (23%), proteasome inhibitor-based (15%), and other (9%); and third-line: ibrutinib-based (41%), rituximab monotherapy (32%), chemotherapy-based (18%), proteasome inhibitor-based (6%), and other (3%).
The overall hospitalization rate was 29% with an average LOS of 12 days. During first-line, second-line, and third-line therapy, approximately 21% (LOS: 10.9 days), 18% (LOS: 6.9 days), and 24% (LOS: 7.3 days) had a hospitalization. Overall, the average total PPPM costs were $13,007, and $13,154, $12,550, and $25,813, respectively.
“There remains significant clinical and economic burden associated with WM among the US Veteran population. Future studies are needed to further understand the variance between treatment patterns and associated economic impact of treatment selection,” Dr Castillo and colleagues concluded.—Janelle Bradley
Castillo JJ, Yang K, Kariburyo F, et al. Real-world evidence on treatment patterns, costs and healthcare resource utilization associated with Waldenström Macroglobulinemia in the Veterans Health Administration population. Presented at: the Virtual 2020 AVAHO Annual Meeting; Sept 12-13, 2020. Abstract 40.
