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Research Article
20 April 2026

Health care resource use in the management of patients with relapsed/refractory diffuse large B-cell lymphoma – Canadian perspective

Authors: Kimberly Guinan https://orcid.org/0000-0001-5245-1178 [email protected], Mathieu Pelletier, Monika Ham, Dipti Tankala https://orcid.org/0009-0008-4849-2442, Nancy Paul Roc, Adi Klil-Drori https://orcid.org/0000-0001-9368-7953, Anthony W Wang, Isabelle Fleury, David MacDonald https://orcid.org/0000-0002-7750-2733, Jean Lachaine https://orcid.org/0000-0002-0791-2518, and Stephane BarakatAuthor Info & Affiliations
Volume 15, Number 6
https://doi.org/10.57264/cer-2025-0187
PDFFormats

Abstract

Aim: Epcoritamab, the first subcutaneous (SC) bispecific approved for relapsed/refractory diffuse large B-cell lymphoma (R/R-DLBCL), offers potential advantages in terms of healthcare resource utilization (HCRU) associated with its SC administration. This study aimed to estimate HCRU and associated costs of R/R-DLBCL treatments, to inform health technology assessment agencies, institutional decision makers and healthcare professionals (HCP) from both a Canadian and Quebec perspective. Secondary objectives included using a societal perspective and estimating chair time and HCP time involved in administering treatments. Materials & methods: A 1-year costing analysis was developed comparing epcoritamab to other R/R-DLBCL treatments, including glofitamab, CAR-T cell therapies, chemotherapy, Pola-BR and Tafa-Len. HCRU and associated costs included pretreatment, administration, monitoring, and adverse event management. Acquisition costs of active treatments were excluded. Multiple time horizons were assessed. Model inputs were retrieved from product labels and validated by clinical experts to reflect practice. Results: From the Canadian and Quebec healthcare system perspective, total 1-year HCRU costs ranged from $11,009 to $54,946 and $10,041 to $54,362, respectively. Epcoritamab ranked as the second least costly comparator after chemotherapy, with notable HCRU savings driven by low administration costs of SC injections and adverse event management costs. Epcoritamab ranked similarly from a societal perspective and scenario analysis evaluating a 2-year time-horizon. Epcoritamab had the lowest annual chair time and HCP time, freeing up resources and HCP availability. Conclusion: Considering the highly constrained Canadian healthcare system, SC epcoritamab offers substantial HCRU-related cost saving, chair time savings and HCP time savings when compared with other available treatments, making it an effective, efficient and patient-centric treatment option for R/R-DLBCL in Canada.

Plain language summary

What is this article about?

Treatments for relapsed/refractory diffuse large B-cell lymphoma (R/R-DLBCL) include a wide array of therapies, each with their own dosing schedules, methods of administration, adverse event rates and monitoring requirements. Epcoritamab, the first subcutaneous (SC) treatment for R/R-DLBCL, has recently received marketing authorization from Health Canada. However, to date, no study has assessed the healthcare resources utilization and associated costs of a novel therapy like epcoritamab versus other R/R-DLBCL treatments. Given the crisis surrounding Canada's healthcare system and workforce, it is imperative to optimize treatment management to alleviate the strain on the healthcare system. Therefore, we performed this research to assess the healthcare resources utilization and associated costs of epcoritamab versus other R/R-DLBCL treatments, to better understand the impact of these treatments on the healthcare system.

What were the results?

From both the Canadian and Quebec healthcare system perspective, epcoritamab was found to be the second least costly treatment option compared with other current and novel treatments for R/R-DLBCL. Epcoritamab was also assessed as the treatment with the least total chair time and healthcare personnel time, due to its SC mode of administration.

What do the results mean?

The healthcare resources saved with SC epcoritamab compared with other treatments in R/R-DLBCL could help alleviate the strain on the Canadian healthcare system. This could allow resources to be redirected to other institutional priorities, and thereby enhance the accessibility and standard of healthcare services provided to Canadian patients.

Shareable abstract

This study suggests that the Canadian healthcare system could benefit from treating R/R-DLBCL with subcutaneous epcoritamab, considering the estimated potential savings in healthcare resources and associated costs. #HEOR #healtheconomics #DLBCL #epcoritamab #healthcareresource #healthcarecosts #HCRU #healthcareresourceutilization #subcutaneous #costinganalysis #value

Supplementary Material

File (supplementary materials.docx)

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
2.
Lymphoma Canada. Diffuse large B cell lymphoma (DLBCL) 2023. https://www.lymphoma.ca/diffuse-large-b-cell-lymphoma/
Google Scholar
• Provides information on the guidelines for treatment of patients with relapsed/refractory diffuse large B-cell lymphoma (R/R-DLBCL) in various provinces of Canada, such as what type of chemotherapy treatment to use and which patients are eligible for a cell transplant.
4.
Lymphoma Canada. Canadian evidence-based guidelines for the treatment of relapsed/refractory diffuse large B-cell lymphoma 2023. https://z9a2f9c2.rocketcdn.me/wp-content/uploads/2021/09/LymphomaCanada_Guideline_Relapsed_Refractory_DLBCL_VF_Digital.pdf
Google Scholar
5.
Westin JR, Oluwole OO, Kersten MJ et al. Survival with axicabtagene ciloleucel in large B-cell lymphoma. N. Engl. J. Med. 389(2), 148–157 (2023).
PubMed
Google Scholar
6.
Thieblemont C, Karimi YH, Ghesquieres H et al. Epcoritamab in relapsed/refractory large B-cell lymphoma: 2-year follow-up from the pivotal EPCORE NHL-1 trial. Leukemia 38(12), 2653–2662 (2024).
PubMed
Google Scholar
•• Evaluates the response rate of adults with relapsed or refractory CD20+ large B-cell lymphoma treated with epcoritamab.
7.
Falchi L, Carlo-Stella C, Morschhauser F et al. Glofitamab monotherapy in pts with relapsed/refractory (R/R) large B-cell lymphoma (LBCL): extended follow-up and landmark analyses from a pivotal Phase II study. J. Clin. Oncol. 41(Suppl. 16), Abstract 7550 (2023).
Google Scholar
8.
Dickinson MJ, Carlo-Stella C, Morschhauser F et al. Glofitamab for relapsed or refractory diffuse large B-Cell Lymphoma. N. Engl. J. Med. 387(24), 2220–2231 (2022).
PubMed
Google Scholar
• Evaluates the response, the duration of response, the survival and the safety of glofitamab in patients with DLBCL. It was found that more than half of the patients had an adverse event of grade 3 or 4.
9.
AbbVie Corporation. Product monograph including patient information: EPKINLY (epcoritamab) 2023. https://www.abbvie.ca/content/dam/abbvie-dotcom/ca/en/documents/products/EPKINLY_PM_EN.pdf
Google Scholar
10.
Hoffmann-La Roche Limited. Product monograph including patient medication information: Columvi (glofitamab) 2023. https://pdf.hres.ca/dpd_pm/00070059.PDF
Google Scholar
11.
Flood CM, Thomas B, McGibbon E. Canada's primary care crisis: Federal Government Response. Healthc. Manage. Forum 36(5), 327–332 (2023).
PubMed
Google Scholar
12.
Canadian Medical Association. Canada's health care crisis: what we need now 2022. https://www.cma.ca/latest-stories/canadas-health-care-crisis-what-we-need-now
Google Scholar
13.
Lei M, Li Q, O'Day K, Meyer K, Wang A, Jun M. Practice efficiency associated with epcoritamab for the treatment ofpatients with relapsed or refractorye B-cell lymphoma from an institutional perspective. Blood 142(Suppl. 1), 7254 (2023).
Google Scholar
•• This micro-cost analysis evaluates the practice efficiency of treating patients with R/R-DLBCL with epcoritamab.
14.
Canadian Agency for Drugs and Technologies in Health (CADTH). CADTH reimbursement recommendation: lisocabtagene maraleucel (Breyanzi).
Google Scholar
15.
Novartis Pharmceuticals Canada Inc. Product monograph including patient medication information: KYMRIAH (Tisagenlecleucel). (2018).
Google Scholar
16.
Canadian Agency for Drugs and Technologies in Health (CADTH). CADTH reimbursement recommendation: axicabtagene ciloleucel (Yescarta). (June 2023).
Google Scholar
17.
Hoffmann-La Roche Limited. Product monograph including patient medication information: POLIVY (Polatuzumab vedotin for injection). (2023).
Google Scholar
18.
Pan-Canadian Oncology Drug Review. pCODR Expert Review Committee (pERC) finale recommendation: polatuzumab vedotin (Polivy). (2021).
Google Scholar
19.
Canadian Agency for Drugs and Technologies in Health (CADTH). CADTH reimbursement recommendation: tafasitamab (Minjuvi). (October 2022).
Google Scholar
20.
Institut National d'excellence and sante et services sociaux (INESSS). Avis transmis au ministre: MINJUVI (Lymphome diffus à grandes cellules B). (October 2022).
Google Scholar
21.
Institut National d'excellence and sante et services sociaux (INESSS). Avis transmis au ministre: POLIVY (Lymphome diffus à grandes cellules B). (May 2021).
Google Scholar
22.
Statistics Canada. Consumer Price Index by product group, monthly, percentage change, not seasonally adjusted, Canada, provinces, Whitehorse, Yellowknife and Iqaluit 2023. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1810000413
Google Scholar
23.
Locke F, Go W, Neelapu S. Development and use of the anti-CD19 chimeric antigen receptor T-cell therapy axicabtagene ciloleucel in large B-cell lymphoma: a review. JAMA Oncol. 6(2), 281–290 (2020).
PubMed
Google Scholar
24.
Ontario Ministry of Health and Long-Term Care. Laboratories and diagnostics branch. Schedule of benefits for laboratory services (Effective 24 July 2023). https://www.health.gov.on.ca/en/pro/programs/ohip/sob/lab/sob_lab_2023.pdf
Google Scholar
25.
Régie de l'assurance maladie du Quebec (RAMQ). Manuel des médecins spécialistes – Rémunération à l'acte 2023. https://www.ramq.gouv.qc.ca/fr/professionnels/medecins-specialistes/manuels/Pages/remuneration-acte.aspx
Google Scholar
26.
Government of Canada. Wages for pharmacists (NOC 3131). Wage data updated on November 17th, 2021. https://www.jobbank.gc.ca/wagereport/occupation/18196
Google Scholar
27.
Government of Canada. Wages, Registered Nurse in Canada 2022. https://www.jobbank.gc.ca/marketreport/wages-occupation/993/ca
Google Scholar
28.
Pettigrew M, Kavan P, Surprenant L, Lim HJ. Comparative net cost impact of the utilization of panitumumab versus cetuximab for the treatment of patients with metastatic colorectal cancer in Canada. J. Med. Econ. 19(2), 135–147 (2016).
PubMed
Google Scholar
29.
Statistics Canada. Employee wages by industry, annual (Table: 14-10-0064-01) 2023. https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=1410006401
Google Scholar
30.
Statistics Canada. Average usual and actual hours worked in a reference week by type of work (full- and part-time), annual (Table: 14-10-0043-01) 2023. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1410004301
Google Scholar
31.
Canadian Agency for Drugs and Technologies in Health (CADTH). Axicabtagene ciloleucel for diffuse large B-Cell lymphoma: economic review report. (2019).
Google Scholar
32.
Abramson JS, Palomba ML, Gordon LI et al. Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): a multicentre seamless design study. Lancet 396(10254), 839–852 (2020).
PubMed
Google Scholar
33.
Schuster SJ, Bishop MR, Tam CS et al. Tisagenlecleucel in adult relapsed or refractory diffuse large B-Cell lymphoma. N. Engl. J. Med. 380(1), 45–56 (2019).
PubMed
Google Scholar
34.
Neelapu SS, Locke FL, Bartlett NL et al. Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-Cell lymphoma. N. Engl. J. Med. 377(26), 2531–2544 (2017).
PubMed
Google Scholar
35.
Locke FL, Ghobadi A, Jacobson CA et al. Long-term safety and activity of axicabtagene ciloleucel in refractory large B-cell lymphoma (ZUMA-1): a single-arm, multicentre, Phase I–II trial. Lancet Oncol. 20(1), 31–42 (2019).
PubMed
Google Scholar
36.
Ontario Ministry of Health and Long-Term Care. Ontario drug benefit (ODB) formulary 2023. https://www.formulary.health.gov.on.ca/formulary/
Google Scholar
37.
Régie de l'assurance maladie du Quebec (RAMQ). Liste des medicaments. (6 July 2023).
Google Scholar
38.
IQVIA Delta PA. (12 July 2023).
Google Scholar
41.
Cancer Care Ontario. Drug formulary - BEND+POLA+RITU. (2022). https://www.cancercareontario.ca/en/drugformulary/regimens/monograph/62866
Google Scholar
42.
43.
Canadian Institute for Health Information. Patient cost estimator. (2019). https://www.cihi.ca/en/patient-cost-estimator
Google Scholar
44.
Cancer Care Ontario. Drug formulary: funded evidence-informed regimens 2023. https://www.cancercareontario.ca/en/drugformulary/regimens
Google Scholar
45.
Sehn LH, Herrera AF, Flowers CR et al. Polatuzumab vedotin in relapsed or refractory diffuse large B-Cell lymphoma. J. Clin. Oncol. 38(2), 155–165 (2020).
PubMed
Google Scholar
46.
Salles G, Duell J, González Barca E et al. Tafasitamab plus lenalidomide in relapsed or refractory diffuse large B-cell lymphoma (L-MIND): a multicentre, prospective, single-arm, phase 2 study. Lancet Oncol. 21(7), 978–988 (2020).
PubMed
Google Scholar
47.
Corazzelli G, Capobianco G, Arcamone M et al. Long-term results of gemcitabine plus oxaliplatin with and without rituximab as salvage treatment for transplant-ineligible patients with refractory/relapsing B-cell lymphoma. Cancer Chemother. Pharmacol. 64(5), 907–916 (2009).
PubMed
Google Scholar
48.
Ontario Ministry of Health and Long-Term Care. Ontario case costing analysis tool. (2018).
Google Scholar
50.
BC Cancer. BC cancer guidelines for prevention and treatment of chemotherapy-induced nausea and vomiting in adults 2022. http://www.bccancer.bc.ca/chemotherapy-protocols-site/Documents/Supportive%20Care/SCNAUSEA_Protocol.pdf
Google Scholar
52.
Prica A, Hay AE, Crump M et al. Evaluating the indirect costs of care associated with salvage chemotherapy for relapsed and refractory aggressive-histology lymphoma: a subset analysis of the Canadian Cancer Trials Group (CCTG) LY.12 Clinical Trial. Curr. Oncol. 28(2), 1256–1261 (2021).
PubMed
Google Scholar
53.
Canadian Agency for Drugs and Technologies in Health (CADTH). CADTH reimbursement recommendation (Draft): epcoritamab (Epkinly). (2024).
Google Scholar
54.
De Cock E, Kritikou P, Sandoval M et al. Time savings with rituximab subcutaneous injection versus rituximab intravenous infusion: a time and motion study in eight countries. PLoS ONE 11(6), e0157957 (2016).
PubMed
Google Scholar
55.
Rummel M, Kim TM, Aversa F et al. Preference for subcutaneous or intravenous administration of rituximab among patients with untreated CD20þ diffuse large B-cell lymphoma or follicular lymphoma: results from a prospective, randomized, open-label, crossover study (PrefMab). Ann. Oncol. 28, 836–842 (2017).
PubMed
Google Scholar
56.
Drummond D, Sinclair D, Gratton J. Troubles in Canada's health workforce: the why, the where, and the way out of shortages. CD Howe Institute, Canada (2022).
Google Scholar
•• Assesses the challenges present in the Canadian healthcare system, therefore highlights the importance of having therapies available that help save resources.
57.
Institut national d'excellence en santé et services sociaux (INESSS). Tisagenlecleucel pour le traitement du lymphome diffus à grandes cellules B récidivant ou réfractair. (2019). https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Therapies_cellulaires/INESSS_Avis_Kymriah_LDGCB.pdf
Google Scholar
58.
nCanadian Institute for Health Informatio. Care in Canadian ICUs. (2016). https://secure.cihi.ca/free_products/ICU_Report_EN.pdf
Google Scholar
59.
Statistics Canada. Labour force characteristics by province, monthly, seasonally adjusted - Table: 14-10-0287-03. (2023). https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1410028703
Google Scholar
|