Rituximab Infusions Costlier When Given in the Hospital than in the Office Setting

Wayne Kuznar

February 2014, Vol 5, No 1 - Economics of Cancer Care


New Orleans, LA—More patients with diffuse large B-cell lymphoma (DLBCL) are receiving rituximab infusions in the hospital setting, incurring greater costs than those receiving infusions in the office or clinic, an examination of medical and pharmacy claims has shown.

Rituximab in combination with CHOP (cyclophosphamide, doxorubi­cin, vincristine, and prednisone) is the recommended first-line therapy for DLBCL, improving overall survival compared with CHOP alone.

In a retrospective study, Carolina Reyes, PhD, of Genentech, South San Francisco, CA, examined differences in treatment patterns, healthcare resource use, and costs among patients with DLBCL receiving rituximab plus chemotherapy in the office or clinic versus in the hospital outpatient setting.

Medical and pharmacy claims from a large, geographically diverse US commercial health plan were used to identify 491 adults with DLBCL with 2 or more claims for rituximab, 65% of whom received infusions in the office or clinic, and 35% of whom received them in the hospital. To be eligible for the analysis, patients were required to be enrolled in the health plan for ≥6 months before and after the date of the first rituximab claim (index date).

The follow-up extended through the episode of care: the date of the first rituximab infusion through 30 days after the last infusion, before a gap in rituximab administration of at least 7 months.

Of the 491 patients, 140 were covered under Medicare Advantage, and 351 were commercially insured. The percentage of patients receiving infusions in the hospital increased from 32% in 2007 to 43% in 2011/2012.

The mean length of episode of care was not significantly different by the site of service: 187 days in the office or clinic versus 178 days in the hospital. The mean number of rituximab infusions was less in the hospital compared with in the office or clinic (4.92 vs 6.52, respectively), as was the mean number of infusions per month (1.01 vs 1.17, respectively).

Of the patients receiving infusions in the office or clinic setting, 93% had evidence of the receipt of combination therapy (rituximab plus chemotherapy) compared with 85% of those receiving treatment in the hospital. The receipt of granulocyte colony-stimulating factor was 87% in patients treated in the office or clinic versus 77% in those treated in the hospital.

The total mean costs during the episode of care, as well as administration costs incurred on days of rituximab infusions, were significantly higher among the hospital cohort compared with the office/clinic cohort.
The unadjusted mean infusion-day costs were higher in the hospital cohort compared with the office/clinic cohort ($12,481 vs $5834, respectively).

“Higher infusion-day costs contributed to higher unadjusted mean per-patient per-month [PPPM] costs among the hospital cohort,” noted Dr Reyes. Total unadjusted PPPM costs in the hospital cohort were significantly higher compared with the office/clinic cohort ($22,325 vs $15,541, respectively).

“These results warrant further investigation to assess the impact of these differences on clinical outcomes by site of care,” according to Dr Reyes.­