Healthcare resource utilization analysis in newly diagnosed mantle cell lymphoma: resource alleviation with adoption of the TRIANGLE ibrutinib regimen without autologous stem cell transplantation

Abstract For younger, fit patients with mantle cell lymphoma (MCL), first-line therapy includes high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). HDCT-ASCT demands considerable healthcare resources and costs and causes acute and long-term complications. The phase 3 TRIANGLE trial found clinically beneficial improvements in overall survival and safety when HDCT-ASCT was replaced with an ibrutinib regimen without ASCT. This study aimed to develop a comprehensive ASCT treatment clinical pathway model for patients newly diagnosed with MCL and assess the impact on hospitalization duration, healthcare resources, and cost. The clinical pathway was modeled using ClipMed ® PPM software-based process analysis. Data were sourced from the IWiG ® reference model for quantitative activity-based health economic evaluation and validated by clinical experts alongside standard operating procedures. Cost inputs were obtained using reimbursement sources and tariff publications in Germany. The total clinical pathway, from ASCT-eligibility assessments, induction therapy, HDCT-ASCT consolidation, and up to 100 days post-ASCT, covered: 49 patient-clinician interaction days; 346 patient services (inpatient and outpatient settings); 1653 processes. HDCT-ASCT involved 23 days’ hospitalization. Healthcare professionals’ time associated with apheresis and HDCT-ASCT, which could be spared with the TRIANGLE ibrutinib regimen without ASCT, totaled 214 h. Costs associated with the total clinical pathway, excluding those associated with severe adverse events, other comorbidities, and long-term complications, amounted to €50,815 per patient. For newly diagnosed ASCT-eligible patients with MCL, HDCT-ASCT is associated with at least 23 hospitalization days, considerable costs, and substantial healthcare resources – assets that could be redirected with adoption of the TRIANGLE ibrutinib regimen without ASCT.