Economic Evaluation of Chimeric Antigen Receptor T-Cell Therapy by Site of Care Among Patients With Relapsed or Refractory Large B-Cell Lymphoma

Abstract

IMPORTANCE Chimeric antigen receptor (CAR) T-cell therapies are currently administered at a limited number of cancer centers and are primarily delivered in an inpatient setting. However, variations in total costs associated with these therapies remain unknown. OBJECTIVE To estimate the economic differences in the administration of CAR T-cell therapy by the site of care and the incidence of key adverse events. DESIGN, SETTING, AND PARTICIPANTS A decision-tree model was designed to capture clinical outcomes and associated costs during a predefined period (from lymphodepletion to 30 days after the receipt of CAR T-cell infusion) to account for the potential incidence of acute adverse events and to evaluate variations in total costs for the administration of CAR T-cell therapy by site of care. Cost estimates were from the health care practitioner perspective and were based on data obtained from the literature and publicly available databases, including the Healthcare Cost and Utilization Project National Inpatient Sample, the Medicare Hospital Outpatient Prospective Payment System, the Medicare physician fee schedule, the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System, and the IBM Micromedex RED BOOK. The model evaluated an average adult patient with relapsed or refractory large B-cell lymphoma who received CAR T-cell therapy in an academic inpatient hospital or nonacademic specialty oncology network.

A Review of Cancer Immunotherapy Toxicity II: Adoptive Cellular Therapies, Kinase Inhibitors, Monoclonal Antibodies, and Oncolytic Viruses

“…The cells are then administered, and patients are monitored for a period ranging from several days to weeks depending on the complications and toxicity that arise. While outpatient therapy has been described and may be associated with increased cost savings, therapy is primarily delivered as an inpatient with some authors advocating for an observation period of at least 9 days [ 7 , 8 ]. To date, there are no published cases of significant dosing errors, intentional overdose, or toxicity related to infusion rate errors.…”

State-of-Art of Cellular Therapy for Acute Leukemia

“…While autologous CAR19-T therapies are extremely promising, this individualized treatment still faces many challenges such as high treatment costs, lengthy vein-to-vein time due to long production processes, and potential manufacturing failures, challenging patients’ access to a life-saving treatment. Current cost estimates for CAR-T treatments are about $450,000, with the bulk of that coming from the cost of CAR-T product manufacturing (~$373,000) [ 23 , 24 ].This cost can be further increased with other CAR-T therapy-related interventions such as pre-conditioning lymphodepletion, adverse event management, and such high treatment-associated costs make CAR-T therapy less accessible to patients-in-need and pose a significant financial burden for the healthcare system to establish it as a standard-of-care for B-ALL.…”

Cell Therapies in Bladder Cancer Management

“…One of the main disadvantages of CAR-T cell therapy is its high costs. The estimated total cost of care associated with the administration of CAR-T cell therapy was $454,611 in an academic hospital inpatient setting [ 62 ]. Another study found that the median total cost of hospitalization resulting from CAR-T cell treatment was $380,052, with a median direct cost of $262,981 [ 63 ].…”