Rituximab Lowers Health Care Costs in DLBCL, Japanese Study Finds

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A new report finds including rituximab in first-line therapy for diffuse large B-cell lymphoma (DLBCL) results in better overall outcomes that more than offset the higher initial cost of therapy.

New research out of Japan finds that including rituximab (Rituxan) in first-line therapy for diffuse large B-cell lymphoma (DLBCL) results in better outcomes and lower overall healthcare costs, despite a price increase for the first-line therapy.

The findings were published in the journal PLOS One.

Corresponding author Saaya Tsutsué, of Celgene Corp., and colleagues said there are relatively little data surrounding health care costs and utilization among patients with DLBCL in Japan. They decided to study treatment patterns and costs in Japan using the Medical Vision Database, isolating patients treated for DLBCL between October 2008 and December 2017. In total, the authors found 6,965 patients.

Of those patients, the vast majority (79.6%) received first-line therapy with rituximab, followed by a gradual switch to chemotherapy without the monoclonal antibody. Including rituximab caused first-line treatment to be the highest across all lines of therapy, the authors said.

However, the direct cost of drugs was not the only important factor in total costs. Health care utilization also made a significant difference, which is where rituximab’s higher cost began to pay for itself.

The best outcomes in terms of health care utilization came for patients who received the R-CHOP regimen (rituximab plus cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone). Those patients underwent an average of 4.0 hospitalizations during the 12-month follow-up period, and had a total length of stay of 95.0 days.

Among patients who received regimens other than R-CHOP, the number of hospitalizations was slightly higher if rituximab was included (4.7 stays versus 4.3 stays) during the follow-up period. However, patients who received chemotherapy without rituximab ended up staying longer in the hospital compared to those who received rituximab. Specifically, patients who received first-line therapy without rituximab had an average length of stay of 125.0 days. Those who were put on first-line R-CVP (rituximab, cyclophosphamide, vincristine sulfate, and prednisone) had a mean hospital stay of 109.0 days. Patients receiving other rituximab-inclusive first-line regimens had an average stay of 124.0 days.

Patients who received first-line R-CHOP also had the best survival rate and the longest time-to-next-treatment (TTNT) among the cohort.

“Our retrospective analysis of clinical practices in Japanese DLBCL patients demonstrated that 1L treatment and inpatient costs were major cost contributors and that the use of 1L R-CHOP was associated with better clinical outcomes at a relatively low mean treatment cost,” the authors concluded.


More broadly, the authors said their analysis shows that in Japan, as in the United States and other countries, the general pattern is to begin with rituximab but then slowly transition away from rituximab in subsequent lines of therapy.

As in other studies, these data showed that increasing age, male gender, and 1L treatment without rituximab were associated with poorer outcomes.

The authors noted some limitations, including limitations of the algorithm, and the fact that overall survival data were based on hospital discharge records, meaning that the study’s overall survival metrics were less robust.

Still, the authors said the data support the use of rituximab-based therapy both in terms of efficacy and in terms of cost.

“During the entire follow-up period, DLBCL patients receiving an R-CHOP regimen achieved the highest survival rate and longest median TTNT with lower inpatient [healthcare resource utilization], resulting in a relatively low mean total treatment cost,” they said.


Tsutsué S, Tobinai K, Yi J, Crawford B. Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma. PLoS One. 2020;15(8):e0237509. doi:10.1371/journal.pone.0237509