Later Lines of Therapy Drive Economic Burden in Indolent Non-Hodgkin Lymphomas

Key Takeaways:

• Comparable treatment patterns: Rituximab monotherapy and bendamustine-based therapies were the most common treatments among patients with follicular lymphoma (FL), Waldenström macroglobulinemia (WM), and marginal zone lymphoma (MZL).
• Higher health care utilization for FL: Patients with FL experienced higher rates of hospitalization during later lines of therapy (LOT), while health care utilization decreased among patients with WZ and MZL.
• Care costs increase with disease progression: The FL cohort accumulated higher care costs than the WZ and MZL cohorts, which increased with succussive LOT due to increasing hospitalization costs.

Non-Hodgkin lymphoma (NHL) includes 2 subgroups: aggressive and indolent lymphomas. Indolent NHLs, including FL, WM, and MZL, are considered incurable and therefore characterized by long-term treatment patterns. This creates a substantial economic burden that increases with disease progression.

Researchers gathered data between October 2015 and June 2021 from the Clinformatics Data Mart Database to evaluate the real-world treatment patterns, health care utilization, and care costs among patients with indolent NHLs, specifically FL, WM, and MZL. Outcomes were assessed across LOT.

The study identified 2805 patients with FL, 791 patients with WM, and 2207 patients with MZL. Each cohort had a follow-up after 20 months.

Treatment Patterns

Among the patients included in the study, approximately 31% received first-line therapies, with the FL subgroup having the highest proportion of patients receiving treatment. The percentage of patients receiving treatment decreased with each successive LOT.

Rituximab monotherapy and bendamustine-based therapies were the most common regimens across cohorts. Across all cohorts, utilization of bendamustine-based therapies decreased in later lines of therapy while rituximab monotherapy usage increased.

Use of R-CHOP was higher among patients with FL while patients in the WZ and MZL cohorts were more likely to be treated with ibrutinib-based therapies.

Health Care Utilization

Outpatient visits were the most common type of health care visit across cohorts.

Hospitalizations and lengths of stay increased with later LOT among patients in the FL cohort.

For the WZ and MZL cohorts, however, health care utilization was higher in earlier LOT, with utilization rates being the lowest among patients with 3 or more LOT. These results were based on small sample sizes, which may explain these trends.

Care Costs

The average per-person-per-month all-cause care costs were $12 402 for FL, $8445 for WZ, and $9580 for MZL. Disease-related costs contributed to over 50% total all-cause costs. Disease-related costs were driven primarily by hospitalization costs, which increased in later LOT.

Across all cohorts, outpatient and emergency department (ED) costs were the lowest among patients with 3 or more LOT.

Pharmacy costs tended to increase with successive LOT. For the MZL cohort, costs were the highest among patients with second-line therapies.

Implications for Managed Care

Despite the wide variety of treatment options, the real-world use of a few select therapies suggests current treatment patterns remain suboptimal.

The study highlighted the substantial economic burden associated with indolent NHLs, particularly for patients with FL. Health care utilization and costs increased with successive LOT, illustrating the need for improved care management.

The authors concluded that “these findings speak to the need for more effective therapeutic options that could be curative or slow disease progression among patients with indolent NHLs.”

Reference

Garg M, Satija A, Song Y, Meade B, Signorovitch J, Gandra S. Real‑world treatment patterns, healthcare resource use, and costs in patients with follicular lymphoma, Waldenström macroglobulinemia, and marginal zone lymphoma: a claims‑based study in the USA. Clin Drug Invest. 2026. doi:10.1007/s40261-026-01592-6