Economic Assessment of Diagnostic Revision in Peripheral T-Cell Lymphoma

Introduction: Peripheral T-cell lymphoma (PTCL) is a rare disease that is challenging to diagnose. A retrospective claims analysis and parallel electronic health records analysis estimated the rate of PTCL diagnostic revision (DR) either to or from other lymphomas at 29.3%, with significantly higher costs for DR than non-DR patients during follow-up. The current study used data from this analysis to estimate the cost of DR in PTCL to US health plans and quantify the potential impact of reducing DR in this population.

Methods: A cost calculator model was developed using pharmacy and medical costs for adult patients in the IBM MarketScan® Commercial and Medicare Supplemental Databases with a PTCL diagnosis from 01/10-06/17, with or without DR (≥1 medical claim for a non-PTCL lymphoma in the year prior to or after the index PTCL diagnosis). Cost data were incorporated for non-DR, DR to PTCL, and DR from PTCL cohorts, and for the DR period (time from initial PTCL diagnosis to non-PTCL diagnosis or vice versa) and subsequent follow-up period. In the current scenario (based on the analysis of MarketScan data), rates of DR were 29.3%, of which 51.4% were DR to PTCL and 48.6% from PTCL. DR periods were 5.0 and 3.7 months, respectively, over a 1-year time horizon. A ‘new’ scenario was included that assumed a 50% reduction in the rate of DR to and from PTCL, and a 50% reduction in the length of DR period.

Results: In a hypothetical 1 million member Medicare plan, based on an estimated 81 adult PTCL patients and assuming a 50% reduction in both the rate of DR and the DR period, the estimated total plan savings annually in the new scenario would be $906,801. Total per patient per month (PPPM) costs for adults in a Medicare health plan with or without a PTCL DR were estimated at $13,064 in the current scenario and $12,131 in the new scenario, representing a savings of $933 PPPM (Table). Savings were largely derived from reduced costs associated with other outpatient services ($385 PPPM) and inpatient services ($367 PPPM) in the new scenario.

Conclusions: This analysis reiterates the need for appropriate diagnostic criteria and expertise when diagnosing PTCL and its subtypes, as accurate and timely diagnosis of PTCL is essential to enable appropriate treatment. Due to the rarity of PTCL, suspected T-cell diagnoses may benefit from a second opinion at an academic center, with research suggesting academic centers provide a more comprehensive diagnostic workup than other centers. Interventions that reduce the rate of DR in PTCL are likely to result in potential cost-savings to US health plans.