Post-infusion CAR-T costs considerably higher at academic inpatient hospitals
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Chimeric antigen receptor T-cell therapy administration cost nearly $33,000 more at academic inpatient hospitals than nonacademic specialty oncology networks, according to study results published in JAMA Network Open.
Most of the difference was due to higher post-infusion costs associated with hospitalization and office visits for patients treated at academic inpatient hospitals.
“Adoptive cell transfer therapies ... are among the most exciting and promising approaches [for] refractory or relapsed lymphoma and other hematologic malignancies,” Gary H. Lyman, MD, MPH, professor in the public health sciences and clinical research divisions at Fred Hutchinson Cancer Research Center and professor of medicine at University of Washington School of Medicine, told Healio. “Unfortunately, such therapy is highly complex, has the potential for serious adverse events often managed in the inpatient setting and is associated with prohibitive cost.”
The treatment is available at a limited number of major centers in the United States. However — because the number of patients with non-Hodgkin lymphoma and other hematologic malignancies eligible for CAR T-cell therapy is growing — strategies that reduce toxicity, improve safety and reduce costs are necessary to increase access to these therapies, Lyman said.
“Outpatient CAR T-cell therapy has the potential for not only reducing health care costs but making such therapies available to a greater number of patients, as has happened with hematopoietic stem cell [transplantation],” he added.
Lyman and colleagues examined the total cost of CAR T-cell therapy administration — the composite total of costs associated with lymphodepletion, acquisition and infusion of CAR T cells, as well as management of post-infusion acute adverse events — for adults with relapsed or refractory large B-cell lymphoma.
The researchers developed a decision tree economic model based on data from secondary studies and did not include real-world patient data. The study conformed to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) reporting guideline for economic evaluations.
The model — developed using values and inputs from publicly available literature or databases — was designed to estimate incidence of acute adverse events and variations in cost for administering CAR T-cell therapy based on site of care.
Results showed estimated total costs of CAR T-cell therapy administration were $454,611 (95% CI, 452,466-458,267) for the academic hospital inpatient setting and $421,624 (95% CI, 417,204-422,325) in the nonacademic specialty oncology network setting.
Researchers conducted additional analyses that excluded costs associated with CAR T-cell therapy acquisition.
They determined costs for hospitalization plus office visits were $53,360 for those treated at academic hospital inpatient settings — equating to 65.3% of the total cost of CAR-T administration — and $23,526 for those treated at nonacademic specialty oncology networks, equating to 48.4% of total costs.
Researchers calculated that CAR T-cell therapy administration within a nonacademic specialty oncology network was associated with a 56% decrease in hospitalization costs and a 20% decrease in office visit costs compared with administration at an academic inpatient setting.
“Within the limitations of any economic analysis based on a variety of assumptions — including the decision choices, the probabilities of specific outcomes and the costs associated with those outcomes — the results indicate that allowing outpatient administration of CAR T-cell therapy with an acceptable level of adverse events could potentially reduce overall costs by an average of over $30,000,” Lyman said.
Lyman and colleagues acknowledged several limitations to their study.
Many clinical and economic assumptions were built into the model used in the study; however, the researchers said this is common for economic studies, and they based their models on similar ones used for previous analyses of CAR T-cell therapy.
Additionally, researchers based adverse event rates on what has been reported in clinical trials, and this may not reflect real-world administration of CAR T-cell therapy. Also, researchers estimated the cost of treating adverse events based on event severity and site of care.
Outpatient CAR T-cell therapy is being considered for highly selected, low-risk patients at major medical centers with significant experience in delivering these therapies. These highly specialized centers have the infrastructure available to make outpatient CAR T-cell therapy possible, Lyman said.
“With confirmatory data from prospective trials and longer and deeper experience, such an approach is likely to gain acceptance and broader use in many centers. This is likely to take a few years before it impacts most treatment centers throughout the country,” Lyman told Healio. “In the meantime, costs of health care — including hospitalization —will continue to rise and likely make the economic argument for outpatient CAR T-cell therapy even more compelling.”
For more information:
Gary H. Lyman, MD, MPH, can be reached at glyman@fredhutch.org.
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