CTCL Patients Who Continue Treatment Use Fewer Hospital Resources, Study Says

Patients with cutaneous T-cell lymphoma (CTCL) who for some reason discontinue their systemic treatments require more monthly emergency room visits, hospital admissions, and longer inpatient stays than those who continue on treatment, a study by the pharmaceutical company Mallinckrodt found.

Researchers estimate that, each month, those who discontinue treatment spend $100 more on emergency rooms than those who stay on it.

The findings were recently presented at the 2019 American Academy of Dermatology Annual Meeting in Washington, D.C., in a poster titled, “Continuation of Systemic Treatment in Patients with Cutaneous T-cell Lymphoma is Associated with Reduced Healthcare Resource Utilization.”

While CTCL patients with early-stage disease are offered topical treatments, those with advanced disease require systemic treatment, including chemotherapy, HDAC inhibitors, antibodies, retinoids, and extracorporeal photopheresis — a procedure where white blood cells are separated from the rest of the blood, treated with toxic compounds, then inserted back into the patient, where dying cells will activate the immune system to fight cancer.

For some of these systemic treatments, there is no recommended duration. Thus researchers examined the impact of treatment discontinuation on healthcare utilization and cost among these patients.

Investigators examined health insurance claims databases from 2010 to 2015. Their retrospective analysis included 1,081 patients, mean age 58, with continuous enrollment three months before and six months after systemic treatment initiation.

Continuers were defined as those receiving treatment for 180 days or longer without a gap longer than 45 days between treatments.

Approximately three in five (61%) CTCL patients were continuers, with a median treatment duration of 12 months. Most patients (85%) were receiving a single therapy, with methotrexate, retinoids, and extracorporeal photopheresis being the most frequently used systemic therapies.

Interestingly, after accounting for characteristics such as age, sex, pre-existing conditions, and prior healthcare resource use, researchers found that patients on extracorporeal photopheresis were three times more likely of being continuers than patients on other systemic treatments.

Each month, patients who continued treatment had 0.04 emergency room visits, compared to 0.1 for those who discontinued. Similarly, discontinuers also had more monthly hospital admissions — 0.06 versus 0.02 — and more inpatient days per month — 0.57 versus 0.17.

This higher resource utilization correlated with significantly higher emergency room costs, with continuers having monthly costs of $61 compared to $169 for discontinuers.

Researchers caution that the findings should be carefully interpreted, particularly because there is no recommended duration for some systemic treatments and the reason for discontinuation is unknown.

Nonetheless, “these data provide important insights on the potential impact of treatment discontinuation on healthcare costs and utilization,” Larisa Geskin, MD, associate professor of dermatology at Columbia University Medical Center and director of the Comprehensive Skin Cancer Center at the Division of Cutaneous Oncology in the Department of Dermatology, said in a press release.

“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,” said Tunde Otulana, MD, senior vice president and chief medical officer at Mallinckrodt. “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.”