Thursday, June 1, 2017

ASCO Preview: Cost of BR vs RCHOP in Follicular Lymphoma

Another ASCO preview. This one is for a session called "Differences in Health Care Costs and Utilization: BR vs RCHOP in Patients with Follicular Lymphoma."


The study looks at a group 6460 FL patients who were diagnosed between 2006 and 2016. Of that group, 2360 were give Rituxan + Bendamustine, and 4100 were given R-CHOP. As the title suggests, the researchers wanted to compare how much the treatments cost and how much healthcare they used after treatment. The healthcare included outpatient visits, emergency room visits, and hospitalizations.

In the end, the B-R was cheaper and required less healthcare.

Some other details that came out of the study: Patients who took B-R were "significantly older" than the R-CHOP group, and had more comorbidities (that is, health problems in addition to FL). They also had lower costs, fewer ER visits and hospitalizations, plus fewer outpatient visits in the 6 months after treatment.

The study seems to give even more reason why B-R is a better choice than R-CHOP as a first treatment for Follicular Lymphoma (along with it being as effective, but with fewer side effects).

I don't doubt that B-R is a better choice in many situations (and it's one that I discussed with my oncologist more than once), but the study does bring up some questions for me. I'm only seeing an abstract -- a short description of the session -- and not the full session. Maybe some of my questions will be answered then.

The kinds of questions I have would get deeper into the patients themselves. If the B-R patients were older and had more health problems, would it make sense that they were given a less aggressive treatment (one with fewer side effects)? The R-CHOP patients, being younger and with fewer health problems, might do better with a more aggressive treatment, wouldn't they? And if they received a more aggressive treatment, wouldn't it increase the chances that they had more health visits? And did the R-CHOP patients have more aggressive disease to begin with?

In other words, was there a good reason for the R-CHOP patients to get that treatment over B-R, one that would justify the costs?

Again, I'm not trying to defend R-CHOP. It has its place in our treatment, though for me personally, I wouldn't have used it as a first treatment. I've always thought of it as a something to keep aside in case of transformation (though even that might not be the only or best option at some point).


(And I know that a lot of you are not from the U.S. I did a little bit of research, just out of curiosity, to see if B-R costs were lower than R-CHOP in other countries:
A 2016 study in Canada found that B-R was more cost-effective than R-CHOP.
A 2016 study in Spain found that initial costs for B-R were higher than for R-CHOP, but over 25 years, B-R costs were slightly lower.
A 2015 study in Colombia found that the cost of B-R was a little higher than R-CHOP, but the Quality of Life returns made B-R a better choice.
A 2014 study in England and Wales found that both B-R and R-CHOP were below what is considered normal for a treatment to be worth the Quality of Life that it provides.


It's interesting that all of those studies used Quality of Life as a measure to compare costs, not just the number of visits to a health practitioner. While that probably plays a part in Quality of Life, there is also more to it than that. It would be interesting to see an up-to-date study that uses that measure.

The other big question I have about this study has to do with how costs were determined, and whether or not those figures are going to remain the same over time. Being the optimist that I am, I am hopeful that our health care system (in the U.S.) will be settled at some point, and people will be able to afford the treatments that make the most sense for them.