Burden of Illness in Follicular Lymphoma with Multiple Lines of Treatment, Italian RWE Analysis

SIMPLE SUMMARY: This study analysed the state-of-the-art of follicular lymphoma in Italy in a real-world clinical setting, giving special attention to patients who underwent three or more treatment lines. The overall message emerging from the analysis is that progression through several lines during the management of patients diagnosed with follicular lymphoma results in more complex clinical status, and more relevant financial implications for sustainability by the National Health Service. Thus, at the forefront of efforts of current research to broaden the landscape of therapeutic strategies to manage this disease, the mortality rates are still high, revealing an unmet clinical need for patients with multiple lines. ABSTRACT: This real-world analysis investigated patients with follicular lymphoma in Italy receiving three or more treatment lines (≥3L), focusing on therapeutic pathways with their rebounds on healthcare resource consumptions and costs. Data were retrieved from administrative databases from healthcare entities covering about 13.3 million residents. Adults diagnosed with follicular lymphoma were identified between January 2015 and June 2020, and among them 2434 patients with ≥3L of treatment during the data availability interval (January 2009 to June 2021) were included. Of them, 1318 were in 3L, 494 in 4L and 622 in ≥5L. A relevant proportion of patients (12–32%) switched to a later line within the same calendar year. At 3-year follow-up (median), 34% patients died. Total mean annual expenses were euro 14,508 in the year preceding inclusion and rose to euro 21,081 at 1-year follow-up (on average euro 22,230/patient/year for the whole follow-up), with hospitalization and drug expenses as weightiest cost items. In conclusion, the clinical and economic burden of follicular lymphoma increases along with later treatment lines. The high mortality rates indicate that further efforts are needed to optimize disease management.