Differences in Treatment Patterns and Health Care Costs among Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia Patients Receiving Rituximab in the Hospital Outpatient Setting versus the Office/Clinic Setting


Objective: To examine whether differences in treatment patterns and health care costs exist among chronic lymphocytic leukemia (CLL) and non-Hodgkin’s lymphoma (NHL) patients receiving rituximab in a hospital outpatient setting versus those receiving rituximab in a physician office/community clinic setting. Methods: This retrospective database study used medical and pharmacy claims (1/2007-7/2012) from a large US health plan. Patients ≥18 years with ≥2 rituximab claims and ≥2 claims for either NHL or CLL were identified. The date of the first rituximab claim were set as the index date, and differences in treatment patterns and health care costs were examined during the period following the index date. Costs were adjusted for patient characteristics using a multivariate regression model. Results: A total of 4441 patients were identified; 3167 received rituximab in the office/clinic setting, and 1274 in the hospital outpatient setting. From 2007 to 2012, the percentage of patients receiving rituximab in the hospital outpatient setting increased from 22% to 39%. Patients treated in the hospital outpatient setting vs. the office/clinic setting had fewer average counts of rituximab infusions (5.60 vs. 7.49, p < 0.001), higher total health care costs (cost ratio = 1.325, p < 0.001), higher infusion day drug and administration costs (cost ratio = 1.509, p < 0.001), and higher rates of ER visits and inpatient stays (both p < 0.001). Conclusions: These findings suggest that site of care may impact treatment patterns and costs of patients receiving rituximab, and additional research is needed to better understand the reason(s) for these differences by site of service.

Share and Cite:

S. Byfield, A. Small, L. Becker and C. Reyes, "Differences in Treatment Patterns and Health Care Costs among Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia Patients Receiving Rituximab in the Hospital Outpatient Setting versus the Office/Clinic Setting," Journal of Cancer Therapy, Vol. 5 No. 2, 2014, pp. 208-216. doi: 10.4236/jct.2014.52026.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] G. M. Keating, “Rituximab: A Review of Its Use in Chronic Lymphocytic Leukaemia, Low-Grade or Follicular Lymphoma and Diffuse Large B-Cell Lymphoma,” Drugs, Vol. 70, No. 11, 2010, pp. 1445-1476. http://dx.doi.org/10.2165/11201110-000000000-00000
[2] F. Hagemeister, “Rituximab for the Treatment of Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukaemia,” Drugs, Vol. 70, No. 3, 2010, pp. 261-272. http://dx.doi.org/10.2165/11532180-00000 0000-00000
[3] R. Marcus, K. Imrie, P. Solal-Celigny, J. V. Catalano, A. Dmoszynska, J. C. Raposo, F. C. Offner, J. Gomez-Codina, A. Belch , D. Cunningham , E. Wassner-Fritsch and G. Stein, “Phase III Study of R-CVP Compared with Cyclophosphamide, Vincristine, and Prednisone Alone in Patients with Previously Untreated Advanced Follicular Lymphoma,” Journal of Clinical Oncology, Vol. 26, No. 28, 2008, pp. 4579-4586. http://dx.doi.org/10.1200/JCO.2007.13.5376
[4] M. Herold, A. Haas, S. Srock, S. Neser, K. H. Al-Ali, A. Neubauer, G. Dolken, R. Naumann, W. Knauf, M. Freund, R.Rohrberg, K. Hoffken, A. Franke, T. Ittel, E. Kettner, U. Haak, U. Mey, C. Klinkenstein, M. Assmann, U. von Grünhagen, East German Study Group Hematology and Oncology Study, “Rituximab Added to First-Line Mitoxantrone, Chlorambucil, and Prednisolone Chemotherapy Followed by Interferon Maintenance Prolongs Survival in Patients with Advanced Follicular Lymphoma: An East German Study Group Hematology and Oncology Study,” Journal of Clinical Oncology, Vol. 25, No. 15, 2007, pp. 1986-1992. http://dx.doi.org/10.1200/JCO.2006.06.4618
[5] M. Pfreundschuh, L. Trümper, A. Osterborg, R. Pettengell, M. Trneny, K. Imrie, D. Ma, D. Gill, J. Walewski, P. L. Zinzani, R. Stahel, S. Kvaloy, O. Shpilberg, U. Jaeger, M. Hansen, T. Lehtinen, A. López-Guillermo , C. Corrado, A. Scheliga, N. Milpied, M. Mendila, M. Rashford, E. Kuhnt, M. Loeffler, MabThera International Trial Group, “CHOP-Like Chemotherapy plus Rituximab versus CHOP-Like Chemotherapy Alone in Young Patients with Good-Prognosis Diffuse Large-B-Cell Lymphoma: A Randomised Controlled Trial by the MabThera International Trial (MInT) Group,” Lancet Oncology, Vol. 7, No. 5, 2006, pp. 379-391. http://dx.doi.org/10.1016/S1470-2045(06)70664-7
[6] B. Coiffier, E. Lepage, J. Briere, R. Herbrecht, H. Tilly, R. Bouabdallah, P. Morel, E. Van Den Neste, G. Salles, P. Gaulard, F. Reyes, P. Lederlin and C. Gisselbrecht, “CHOP Chemotherapy plus Rituximab Compared with CHOP Alone in Elderly Patients with Diffuse Large-B-Cell Lymphoma,” New England Journal of Medicine, Vol. 346, No. 4, 2002, pp. 235-242. http://dx.doi.org/10.1056/NEJMoa011795
[7] M. Hallek, K. Fischer, G. Fingerle-Rowson, A. M. Fink, R. Busch, J. Mayer, M. Hensel, G. Hopfinger, G. Hess, U. von Grünhagen, M. Bergmann, J. Catalano, P. L. Zinzani, F. Caligaris-Cappio, J. F. Seymour, A. Berrebi, U. Jager, B. Cazin, M. Trneny, A. Westermann, C. M. Wendtner, B. F. Eichhorst, P. Staib, A. Bühler, D. Winkler, T. Zenz, S. Bottcher, M. Ritgen, M. Mendila, M. Kneba, H. Dohner, S. Stilgenbauer, International Group of Investigators, German Chronic Lymphocytic Leukaemia Study Group, “Addition of Rituximab to Fludarabine and Cyclophosphamide in Patients with Chronic Lymphocytic Leukaemia: A Randomised, Open-Label, Phase 3 Trial,” Lancet, Vol. 376, No 9747, 2010, pp. 1164-1174.
[8] Avalere Health, LLC, “Total Cost of Cancer Care by Site of Service: Physician Office vs Outpatient Hospital,” 2012. http://www.avalerehealth.net/news/2012-04-03_COA/Cost_of_Care.pdf
[9] K. Fitch, B. Pyenson, Milliman Inc., “Siteof Service Cost Differences for Medicare Patients Receiving Chemotherapy,” 2011. http://publications.milliman.com/publications/health-published/pdfs/site-of-service-cost-differences.pdf
[10] H. Quan, V. Sundararajan, P. Halfon, A. Fong, B. Burnand, J. C. Luthi, L. D. Saunders, C. A. Beck, T. E. Feasby and W. A. Ghali, “Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data,” Medical Care, Vol. 43, No. 11, 2005, pp. 1130-1139.
[11] Genentech, “Rituxan Package Insert,” 2013. http://www.gene.com/download/pdf/rituxan_prescri bing.pdf
[12] The Medicare Payment Advisory Commission (MedPAC), “Report to the Congress: Medicare Payment Policy,” 2012. http://medpac.gov/chapters/Mar12_Ch03.pdf
[13] T. U. Guidi, “Medicare’s Hospital Outpatient Prospective Payment System: OPPS 101,” Journal of Oncology Practice, Vol. 6, No. 6, 2010, pp. 321-324. http://dx.doi.org/10.1200/JOP.2010.000163
[14] B. O. Wynn, P. S. Hussey and T. Ruder, “Policy Options for Addressing Medicare Payment Differentials Across Ambulatory Settings,” 2011. http://www.rand.org/pubs/technical_reports/TR979.html
[15] W. R. Robinson and J. Beyer, “Impact of Shifting from Officeto Hospital-Based Treatment Facilities on the Administration of Intraperitoneal Chemotherapy for Ovarian Cancer,” Journal of Oncology Practice, Vol. 6, No. 5, 2010, pp. 232-235. http://dx.doi.org/10.1200/JOP.000058
[16] M. Jacobson, C. C. Earle, M. Price and J. P. Newhouse, “How Medicare’s Payment Cuts for Cancer Chemotherapy Drugs Changed Patterns of Treatment,” Health Affairs, Vol. 29, No. 7, 2010, pp. 1391-1399. http://dx.doi.org/10.1377/hlthaff.2009.0563
[17] R. M. Conti and P. B. Bach, “Cost Consequences of the 340B Drug Discount Program,” The Journal of the American Medical Association, Vol. 309, No. 19, 2013, pp. 1995-1996. http://dx.doi.org/10.1001/ jama.2013.4156
[18] US Department of Health and Human Services, Office of the Inspector General, “Payment for Drugs under the Hospital Outpatient Prospective Payment System,” 2010. http://oig.hhs.gov/oei/reports/ oei-03-09-00420.pdf
[19] Community Oncology Alliance, “Community Oncology Practice Impact Report: The Changing Landscape of Cancer care,” 2012. http://www.communityoncology.org/pdfs/community-oncology-practice -impact-report.pdf
[20] J. Zoeller and P. Sonnenreich, “A Survey of Oncology Trends: The Oncologist’s Perspective,” P & T, Vol. 36, No. 12, 2011, pp. 82682-82688.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.