title: Treatment cost and life expectancy of diffuse large B-cell lymphoma (DLBCL): a discrete event simulation model on a UK population-based observational cohort.
abstract: BACKGROUND
  Diffuse large B-cell lymphoma (DLBCL) is the commonest non-Hodgkin lymphoma. Previous studies examining the cost of treating DLBCL have generally focused on a specific first-line therapy alone; meaning that their findings can neither be extrapolated to the general patient population nor to other points along the treatment pathway. Based on empirical data from a representative population-based patient cohort, the objective of this study was to develop a simulation model that could predict costs and life expectancy of treating DLBCL.
  
  
  METHODS
  All patients newly diagnosed with DLBCL in the UK's population-based Haematological Malignancy Research Network ( www.hmrn.org ) in 2007 were followed until 2013 (n = 271). Mapped treatment pathways, alongside cost information derived from the National Tariff 2013/14, were incorporated into a patient-level simulation model in order to reflect the heterogeneities of patient characteristics and treatment options. The NHS and social services perspective was adopted, and all outcomes were discounted at 3.5 % per annum.
  
  
  RESULTS
  Overall, the expected total medical costs were £22,122 for those treated with curative intent, and £2930 for those managed palliatively. For curative chemotherapy, the predicted medical costs were £14,966, £23,449 and £7376 for first-, second- and third-line treatments, respectively. The estimated annual cost for treating DLBCL across the UK was around £88-92 million.
  
  
  CONCLUSIONS
  This is the first cost modelling study using empirical data to provide 'real world' evidence throughout the DLBCL treatment pathway. Future application of the model could include evaluation of new technologies/treatments to support healthcare decision makers, especially in the era of personalised medicine.
authors.affiliation: Epidemiology and Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK. han-i.wang@york.ac.uk.
authors.forename: Han-I
authors.initials: HI
authors.lastname: Wang
authors.affiliation: Epidemiology and Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Smith
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
authors.forename: Eline
authors.initials: E
authors.lastname: Aas
authors.affiliation: Epidemiology and Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK.
authors.forename: Eve
authors.initials: E
authors.lastname: Roman
authors.affiliation: Epidemiology and Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Crouch
authors.affiliation: Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: Burton
authors.affiliation: Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull, UK.
authors.forename: Russell
authors.initials: R
authors.lastname: Patmore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008017:Life Expectancy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000191:economics* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D010166:Palliative Care / Q000191:economics; D013222:State Medicine; D013997:Time Factors; D006113:United Kingdom
keywords: Cost; DLBCL; Diffuse large B-cell lymphoma; Discrete event simulation; Patient-level simulation