CAR T-cell therapy cost-effective compared with past treatments

SAN DIEGO — Chimeric antigen receptor T-cell therapy has improved health outcomes at a more cost-effective rate than other cancer treatments, according to a study presented at ASH Annual Meeting and Exposition.

Data suggest that price increases of pharmaceutical oncology treatments have outpaced survival improvements. However, these study findings reveal that chimeric antigen receptor (CAR) T-cell therapy represents a break with the past trends of low-value innovation, according to the researchers.

“I think CAR T therapy clearly was significantly better in terms of incremental qualities when compared with both other treatments for hematologic cancers and treatments for nonhematologic cancers,” James Baumgardner, PhD, senior research economist at Precision Health Economics, said during his presentation. “In terms of trends, the introduction of CAR T therapy represents a major break of the trend of declining incremental effectiveness while showing similar cost-effectiveness to other innovations.”

Researchers identified all analyses of pharmaceutical treatments for cancer published since 2007 in the Tufts Medical Center Cost-Effectiveness Analysis Registry, which quantifies health benefits in terms of quality-adjusted life-years (QALYs). Researchers derived cost-utility analysis data for CAR T-cell therapies from a study conducted in 2018 by the Institute for Clinical and Economic Review.

The analysis compared interventions for nonhematologic cancers with non-CAR T interventions for hematologic cancers, which were compared with CAR T-cell therapy.

From these data sets, researchers included 103 QALY and 109 cost/QALY measures.

Regression analysis was used to offset outside factors such as discount rates, time horizon, the number of years between publication and approval of the intervention, and an indicator for rare diseases.

The regression analysis showed that, for anticancer interventions overall, incremental QALYs gained have declined with approval year by 0.079 (95% CI, -0.128 to -0.03) per year. Cost-effectiveness for treatments also worsened, with an increase of $36,147 (95% CI, –29,575 to 101,868) a year.

However, results showed that CAR T-cell therapy provides 5.17 (95% CI, 4.09-6.25) more incremental QALYs than pharmaceutical cancer innovations outside of hematology and 4.67 (95% CI, 3.44-5.9) more incremental QALYs than other treatments within hematology.

Treatments within hematology other than CAR-T cell therapy provided 0.5 (95% CI, –0.09 to 1.09) more incremental QALYs than new treatments outside of hematology.

Researchers noted that the differences in cost per QALY between CAR T-cell therapy and other treatments did not reach statistical significance.

The results are limited by the fact that researchers depended on peer reviews in the publication process, Baumgardner said during the presentation.

“What these studies tend to do is look at the relevant comparator at the time,” Baumgardner said. “We are depending on the published literature and the review process in the published literature that these are the relevant comparators being chosen.” – by John DeRosier

Reference:

Baumgardner J, et al. Abstract 322. Presented at: ASH Annual Meeting and Exposition; Dec. 1-4, 2018; San Diego.

Disclosures : Baumgardner and other study authors report employment with Precision Health Economics. Please see the abstract for all authors’ relevant financial disclosures.