Cost Analysis of R-CHOP Versus Dose-Adjusted R-EPOCH in Treatment of Diffuse Large B-Cell Lymphoma with High-Risk Features

Authors

Bhagirathbhai Dholaria^{1, 2, *,} , Yenny Alejandra Moreno Vanegas^{2, 3,} , Nancy Diehl⁴, Aaron C. Spaulding^5, , Sue Visscher⁶, Han W. Tun², Sikander Ailawadhi^2, , Prakash Vishnu^{2, 7}

¹Department of Hematology-Oncology, Pierce Ave, Preston Research Building, Vanderbilt University Medical Center, Nashville, TN 37232, USA

²Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA

³Department of Internal Medicine, St. Elizabeth Medical Center, Boston, MA, USA

⁴Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA

⁵Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA

⁶Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

⁷Harrison Health Partners Hematology and Oncology, Bremerton, WA, USA

^*Corresponding author. Postal address: Vanderbilt University Medical Center, 2220 Pierce Avenue, 777 PRB, Nashville, TN 37232, USA.
Email: bhagirathbhai.r.dholaria@vumc.org

DOI

10.2991/chi.d.200410.001How to use a DOI?

Keywords

Diffuse large B-cell lymphoma; chemotherapy; outcomes research; combined antineoplastic chemotherapy protocols

Abstract

Dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA.R-EPOCH) is used for upfront treatment of high-risk diffuse large B cell lymphoma (DLBCL). In this study, we compared the outcomes in patients with high-risk DLBCL who received frontline rituximab, cycophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or DA.R-EPOCH immunochemotherapy. Outcomes and treatment-related cost were analyzed. DLBCL with one of the following features were included in the study: MYC ± BCL2 or BCL6 rearrangement by FISH or MYC overexpression by immunohistochemistry, Ki67 index ≥ 80% or nongerminal center immunophenotype, tumor measuring ≥5 cm and NCCN- IPI score ≥4. A total of 80 patients were treated with R-CHOP (n = 52, 65%) or DA.R-EPOCH (n = 28, 35%), with a median follow-up of 11.2 months (range: 0.7–151.3 months). The hazard ratios (HRs) for progression-free survival and overall survival were 0.79 [95% confidence interval (CI) 0.28%–2.29%, p = 0.67] and 0.86 (95% CI 0.26%–2.78%, p = 0.80), respectively for DA.R-EPOCH compared to R-CHOP. The total mean cost was USD106,940 ± USD39,351 and USD58,509 ± 24,588 for DA.R-EPOCH and R-CHOP respectively (p < 0.001). In our analysis, DA.R-EPOCH resulted comparable clinical outcomes and increased treatment-related expenses compared to R-CHOP in high-risk DLBCL.

Copyright

© 2020 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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TY  - JOUR
AU  - Bhagirathbhai Dholaria
AU  - Yenny Alejandra Moreno Vanegas
AU  - Nancy Diehl
AU  - Aaron C. Spaulding
AU  - Sue Visscher
AU  - Han W. Tun
AU  - Sikander Ailawadhi
AU  - Prakash Vishnu
PY  - 2020
DA  - 2020/04/23
TI  - Cost Analysis of R-CHOP Versus Dose-Adjusted R-EPOCH in Treatment of Diffuse Large B-Cell Lymphoma with High-Risk Features
JO  - Clinical Hematology International
SP  - 117
EP  - 124
VL  - 2
IS  - 3
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.d.200410.001
DO  - 10.2991/chi.d.200410.001
ID  - Dholaria2020
ER  -