Predictors of Emergency Room (ER) Visits and Hospitalizations in Patients with Mantle Cell Lymphoma (MCL) Treated with Chemotherapy

Background: Understanding the predictors of increased healthcare resource utilization is essential for better management of patients with MCL, especially as new agents enter the market. This study evaluated predictors for ER visits and hospitalizations in patients with newly diagnosed and relapsed MCL treated with chemotherapy.

Methods: Using claims data (MORE² Registry^®), patients treated with antineoplastics from August 2009-2013 for MCL were retrospectively identified by ICD-9 codes (200.4, 200.40 – 200.48). Patients with secondary malignancies, pregnancy, and age <18 were excluded. Univariate logistic regression analysis was conducted to determine covariates associated with ER visits and hospitalizations. Results for significant variables were reported as odds ratio/p-value. Odds ratio >1 indicates increase in chance of events.

Results: A total of 449 patients with MCL were identified. Median age at diagnosis was 71 years, 70% were male, 61% had Medicare primary insurance, 32% were treated in the relapsed setting, 50% had ER visits, and 53% had hospitalizations throughout their treatment history. Significant increases in ER visits and hospitalizations were associated with the following factors (OR/p-value): chemotherapy duration (ER: 1.001/.046, hospitalization: 1.001/.01), supportive care (ER: 2.249/.014, hospitalization: 2.56/.004), number of MCL related adverse events (ER: 10.571/<.000, hospitalization:  39.282/<.000), and treatment following relapse (ER: 1.771/.005, hospitalization: 2.012/.001). Significant variables associated with a decrease in ER visits were male gender (0.576/.008) and having commercial insurance (0.548/.009). Age was associated with ER increase (1.024/.024). Patients treated in the Northeast region of the US were more likely to be hospitalized (1.897/.005).

Conclusions: This retrospective study shows that older patients with MCL had a higher likelihood of ER visits, while male patients and patients with commercial insurance had a lower likelihood of ER visits. Regional differences impacted hospitalizations. Adverse events, supportive care, and duration of treatment were associated with increases in hospitalizations and ER visits. These data warrant consideration of age and comorbidity-adjusted treatment in MCL patients eligible for treatment with antineoplastics.