Venous-thromboembolism and associated health care utilization in elderly patients with diffuse large B cell lymphoma.
diffuse large B cell lymphoma
elderly
health care utilization
venous thromboembolism
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
15 06 2022
15 06 2022
Historique:
revised:
17
02
2022
received:
23
09
2021
accepted:
09
03
2022
pubmed:
2
4
2022
medline:
24
5
2022
entrez:
1
4
2022
Statut:
ppublish
Résumé
Patients with lymphoma have an increased risk of venous thromboembolism (VTE). The authors examined the risk of VTE and subsequent health care utilization in elderly patients with diffuse large B cell lymphoma (DLBCL). A total of 5537 DLBCL patients ≥66 years old enrolled in Medicare from the Surveillance, Epidemiology, and End Results registry and a noncancer control group of Medicare beneficiaries (n = 5537) were identified. Cumulative incidence function to examine the risk of VTE 12 months after DLBCL diagnosis was used. Fine and Gray method was used to examine the risk factors associated with VTE risk in multivariable models. Total number of hospitalizations, outpatient visits, and Medicare spending were compared in DLBCL patients with and without VTE. VTE was diagnosed in 8.3% DLBCL patients and 1.5% controls, yielding an 8.6-fold higher risk of VTE in DLBCL in adjusted analysis (95% confidence interval [CI], 6.62-11.20; P < .001). Multivariable regression analysis showed that precancer VTE history was associated with an increased risk of developing VTE after a DLBCL diagnosis (hazard ratio [HR], 5.39; 95% CI, 4.39-6.63), and Asian individuals were associated with a lower risk (HR, 0.54; 95% CI, 0.29-1.00). Patients newly diagnosed with VTE after lymphoma had a 1.7-fold higher rate of hospitalization and a 1.2-fold higher rate of outpatient visits compared to those without, resulting in excess Medicare spending of $22,208 in the first year after DLBCL diagnosis. Elderly patients with DLBCL have an elevated risk of VTE resulting in excess health care utilization. VTE history before DLBCL was associated with increased risk of post-DLBCL VTE, and Asian individuals were associated with a lower risk of VTE.
Sections du résumé
BACKGROUND
Patients with lymphoma have an increased risk of venous thromboembolism (VTE). The authors examined the risk of VTE and subsequent health care utilization in elderly patients with diffuse large B cell lymphoma (DLBCL).
METHODS
A total of 5537 DLBCL patients ≥66 years old enrolled in Medicare from the Surveillance, Epidemiology, and End Results registry and a noncancer control group of Medicare beneficiaries (n = 5537) were identified. Cumulative incidence function to examine the risk of VTE 12 months after DLBCL diagnosis was used. Fine and Gray method was used to examine the risk factors associated with VTE risk in multivariable models. Total number of hospitalizations, outpatient visits, and Medicare spending were compared in DLBCL patients with and without VTE.
RESULTS
VTE was diagnosed in 8.3% DLBCL patients and 1.5% controls, yielding an 8.6-fold higher risk of VTE in DLBCL in adjusted analysis (95% confidence interval [CI], 6.62-11.20; P < .001). Multivariable regression analysis showed that precancer VTE history was associated with an increased risk of developing VTE after a DLBCL diagnosis (hazard ratio [HR], 5.39; 95% CI, 4.39-6.63), and Asian individuals were associated with a lower risk (HR, 0.54; 95% CI, 0.29-1.00). Patients newly diagnosed with VTE after lymphoma had a 1.7-fold higher rate of hospitalization and a 1.2-fold higher rate of outpatient visits compared to those without, resulting in excess Medicare spending of $22,208 in the first year after DLBCL diagnosis.
CONCLUSIONS
Elderly patients with DLBCL have an elevated risk of VTE resulting in excess health care utilization. VTE history before DLBCL was associated with increased risk of post-DLBCL VTE, and Asian individuals were associated with a lower risk of VTE.
Identifiants
pubmed: 35363373
doi: 10.1002/cncr.34210
pmc: PMC9133215
mid: NIHMS1790771
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2348-2357Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR003097
Pays : United States
Informations de copyright
© 2022 American Cancer Society.
Références
Am J Med. 2010 Oct;123(10):935-41
pubmed: 20920696
Blood Cancer J. 2018 Jun 7;8(6):54
pubmed: 29884791
Thromb Res. 2010 Dec;126(6):477-80
pubmed: 21126629
Med Care. 2002 Aug;40(8 Suppl):IV-3-18
pubmed: 12187163
J Thromb Haemost. 2018 Apr;16(4):670-679
pubmed: 29431904
Br J Cancer. 2005 Apr 25;92(8):1349-51
pubmed: 15798767
Leuk Lymphoma. 2016 Dec;57(12):2771-2776
pubmed: 27266904
Bone Marrow Transplant. 2001 Dec;28(11):1001-11
pubmed: 11781608
Blood. 2010 Jul 1;115(26):5322-8
pubmed: 20378755
J Natl Cancer Inst Monogr. 2020 May 1;2020(55):3-13
pubmed: 32412076
Thromb Res. 2015 Nov;136(5):917-23
pubmed: 26371409
Cancers (Basel). 2020 May 20;12(5):
pubmed: 32443753
Clinicoecon Outcomes Res. 2013;5:101-8
pubmed: 23430767
Blood. 2008 May 15;111(10):4902-7
pubmed: 18216292
Eur J Haematol. 1995 Mar;54(3):186-94
pubmed: 7720839
Cancer Res Treat. 2016 Jan;48(1):312-21
pubmed: 25761485
Arch Intern Med. 2004 Aug 9-23;164(15):1653-61
pubmed: 15302635
J Natl Compr Canc Netw. 2019 Jul 1;17(7):840-847
pubmed: 31319391
Br J Haematol. 2007 Oct;139(2):289-96
pubmed: 17897305
Thromb Res. 2018 Apr;164 Suppl 1:S112-S118
pubmed: 29703467
J Thromb Haemost. 2007 Mar;5(3):632-4
pubmed: 17319909
Arch Intern Med. 2002 May 27;162(10):1182-9
pubmed: 12020191
Hematology Am Soc Hematol Educ Program. 2013;2013:684-91
pubmed: 24319253
J Clin Oncol. 2020 Feb 10;38(5):496-520
pubmed: 31381464
Thromb Res. 2016 Jul;143:86-90
pubmed: 27208462
J Thromb Haemost. 2006 Mar;4(3):529-35
pubmed: 16460435
Arch Intern Med. 1998 Mar 23;158(6):585-93
pubmed: 9521222
Thromb Res. 2014 May;133 Suppl 2:S23-8
pubmed: 24862141
Arch Intern Med. 2000 Mar 27;160(6):809-15
pubmed: 10737280
Cancer. 2007 Nov 15;110(10):2339-46
pubmed: 17918266
J Med Econ. 2020 Apr;23(4):323-329
pubmed: 31818164
J Manag Care Pharm. 2007 Jul-Aug;13(6):475-86
pubmed: 17672809
Thromb Res. 2012 Sep;130(3):e6-12
pubmed: 22507288
Cancer. 2019 Dec 15;125(24):4498-4508
pubmed: 31469420
Am J Hematol. 2020 Aug;95(8):918-926
pubmed: 32311162
Med Oncol. 2017 Dec 4;35(1):5
pubmed: 29209847
Thromb Res. 2010 Jul;126(1):61-7
pubmed: 20430419
Thromb Haemost. 2017 Apr 27;:
pubmed: 28447710
Cancer. 2003 Sep 15;98(6):1239-42
pubmed: 12973848
Leuk Lymphoma. 2006 Jun;47(6):1029-33
pubmed: 16840193
J Clin Oncol. 2006 Jan 20;24(3):484-90
pubmed: 16421425
Cancers (Basel). 2018 Oct 11;10(10):
pubmed: 30314362
Am J Hematol. 2016 Oct;91(10):1014-9
pubmed: 27380861