A Systematic Literature Review of the Economic and Healthcare Resource Utilization Burden of Relapsed/Refractory Follicular Lymphoma

Objective To quantify the economic or healthcare resource utilization (HCRU) burden and examine the value of interventions for relapsed or refractory (R/R) follicular lymphoma (FL). Methods The PubMed and Embase databases were searched for full-text studies and conference abstracts published between 1 January 2019 and 31 December 2023 that reported either the economic or HCRU burden of R/R FL or reported the results of health economic models assessing interventions for R/R FL. A supplemental manual search was also undertaken to identify conference abstracts that may not have been indexed in the primary databases. A data extraction sheet was used to develop evidence tables. Results A total of 30 records were included spanning 11 retrospective or prospective studies, 11 cost-effectiveness evaluations, and 8 other economic models. Costs and HCRU generally tended to increase as the line of therapy increased, reaching over US$400,000 annually in later lines. Costs associated with recently approved chimeric antigen receptor T-cell therapy (CAR-T) ranged from US$450,000 to over US$700,000 per patient. Economic models evaluating novel therapies, such as CAR-T, tazemetostat, and mosunetuzumab, estimated they would generally be cost-effective and have minimal budget impact or cost-savings. However, these models noted considerable assumptions regarding treatment duration and discontinuation. Real-world costs and resource use for newly approved therapies including CAR-Ts and bispecifics were limited. Conclusions The burden of R/R FL is substantial and increases as patients progress. Considerable gaps exist for the real-world impact of novel therapies, including CAR-Ts and bispecifics, on the economic burden and will need to be studied to properly assess their value.