Inferior progression-free survival for Thai patients with diffuse large B-cell lymphoma treated under Universal Coverage Scheme: the impact of rituximab inaccessability

• Main Authors: Tanin Intragumtornchai, Udomsak Bunworasate, Noppadol Siritanaratkul, Archrob Khuhapinant, Weerasak Nawarawong, Lalita Norasetthada, Arnuparp Lekhakula, Pairaya Rujirojindakul, Chittima Sirijerachai, Kanjana Chansung, Tawatchai Suwanban, Suporn Chuncharunee, Pimjai Niparuck, Somchai Wongkhantee, Wichean Mongkonsritragoon, Tontanai Numbenjapon
• Format: Journal
• Published: 2018
• Subjects: Biochemistry, Genetics and Molecular Biology; Medicine
• Online Access: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84870893023&origin=inward; http://cmuir.cmu.ac.th/jspui/handle/6653943832/52304
• Institution: Chiang Mai University

The impact of health insurance with inequitable rituximab coverage on the survival of patients with diffuse large B-cell lymphoma (DLBCL) has never been reported. We conducted a nationwide multicenter analysis on the outcome of 553 adult patients consecutively diagnosed with DLBCL between July 2003 and June 2006, in whom treatment cost was reimbursed under the Civil Servant Medical Benefit Scheme (CSMBS) (n =201) or the Universal Coverage Scheme (UCS) (n =352). The international prognostic index was comparable between the two payment groups. Rituximab-based therapy was administered in 45.3% and 3.1% of CSMBS and UCS patients, respectively (p <0.001). With a median follow-up of 24.6 months, the 6-year progression-free survival (PFS) was superior for CSMBS patients (34.2 vs. 23.2%, p =0.005). "Not treated with rituximab-based therapy" was the strongest adverse prognostic feature indicating a short PFS (hazard ratio 2.1, p <0.001). It is concluded that lack of access to rituximab is the principal factor accounting for the inferior PFS observed in Thai patients with DLBCL who are treated under the UCS. © 2013 Informa UK, Ltd.