Continuing Systemic Treatment in Cutaneous T-Cell Lymphoma Associated With Lower Healthcare Costs

Results presented March 4, 2019, at the American Academy of Dermatology meeting show that continuing systemic treatment in cutaneous T-cell lymphoma (CTCL) was associated with less time in the hospital and the emergency department (ED). Monthly ED costs were $100 higher, on average, for those who interrupted treatment.

The data were drawn from a retrospective analysis of claims data from 1081 patients with CTCL who were enrolled in their health plan 3 months before and 6 months after they began systemic treatment for their condition. Continuing systemic treatment was defined as staying with treatment for up to 180 days without a gap of 45 days or more. The claims covered the time frame of 2010 to 2015.

According to the Cutaneous Lymphoma Foundation, a systemic therapy refers to treatment that, once absorbed, reaches the bloodstream and is distributed throughout the body. A statement from Mallinckrodt, which supported the study, acknowledged that there are no recommended treatment durations for some systemic therapies. Mallinkrodt is the maker of extracorporeal photopheresis to treat CTCL.

The study found the following:

• 663 patients were defined as continuers; 418 were discontinuers, meaning they had a gap of 45 days or more within a 180-day period.
• Continuers had 0.04 ED visits per month, whereas those who discontinued treatment had 0.10 hospitalizations (P = .002).
• Continuers had 0.02 hospitalizations per month; those who discontinued treatment had 0.06 hospitalizations per month (P <.001).
• Continuers had 0.17 monthly inpatient hospital days, whereas those who discontinued treatment had 0.57 days in the hospital per month (P <.001).
• Monthly ED costs were $61.33 for those who continued treatment and $169.17 for those who discontinued treatment (P = .02).

“This is one of the first studies of its kind to look at the potential resource and cost impact of continuation of systemic therapy for CTCL and demonstrates our commitment to provide data to support informed decision-making,” Tunde Otulana, MD, senior vice president and chief medical officer at Mallinckrodt, said in a statement. “It is an important addition to the body of knowledge on CTCL, as examining resource utilization and costs can lead to improvements in healthcare overall.”

In an email, a Mallinckrodt spokesperson said a clinician’s treatment decision in CTCL could be based on multiple factors. Because this type of information is not available in claims databases, the reasons for discontinuation of systemic treatment have not been well studied. It is unknown if treatment interruptions were due to financial toxicity.

Treatment duration is not addressed in guidelines by either the American Society of Clinical Oncology or the National Comprehensive Cancer Network, according to the company.