CAR-T provides value despite high price tag, oncologists say
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Sixty percent of hematologist-oncologists believe chimeric antigen receptor T-cell therapies provide clinical value at their current price, according to survey results presented at ASH Annual Meeting and Exposition.
Fifteen percent of those surveyed indicated CAR-T costs are reasonable given the breakthrough nature of the treatment, and 45% indicated they feel costs of the therapy are high but not inappropriate based on their effectiveness.
Only 3% of survey respondents indicated they would not refer patients for CAR-T based on current costs. However, 39% of still identified cost as a top barrier to them recommending the therapy for their patients.
“Oncologists no longer feel the cost of CAR-T is prohibitive,” Ajeet Gajra, MD, MBBS, FACP, chief medical officer at Cardinal Health and clinical professor of medicine at SUNY Upstate Medical University, told Healio. "We are definitely seeing a shift in the mindset. In the early days, folks thought it was just too expensive and limited its use for that reason.”
Gajra and colleagues conducted a descriptive online survey of 371 U.S.-based oncologists in their provider network between January and April. Most respondents (72%) characterized their professional setting as community-based practices.
Nearly three-quarters (72%) of those surveyed reported they referred at least one patient for CAR-T since it became commercially available in the United States in 2017.
More than half (53%) had referred at least one patient in the 6 months prior to survey completion. Among this group, 16% indicated none of the patients they had referred in the prior 6 months ultimately received CAR-T.
Gajra acknowledged confusion among physicians when they began referring patients after CAR-T first received approval for commercial use.
“Oftentimes patients were deemed ineligible by the providing center or they were referred too late in the course of their disease and, ultimately, did not receive the therapy,” he said.
This survey’s results show improvement in both areas compared with a similar survey Gajra’s company conducted 3 years ago.
Despite there being several challenges to increased utilization of CAR-T, fewer oncologists reported major barriers to receiving the therapy, Gajra said.
More than a third (34%) of respondents indicated slow approval by payers is the largest challenge in the CAR-T referral process, followed by a slow intake process by the providing center (23%). Forty percent of respondents characterized patient deterioration prior to treatment as a challenge of CAR-T.
However, 30% of survey respondents said they did not face any challenges referring patients for CAR-T.
“In the past, there were concerns about CAR-T manufacturing that have not bubbled to the surface in this survey,” Gajra told Healio. “This may speak to the fact that CAR-T manufacturers are doing a better job of speeding up the process, which in the past experienced bottlenecks.”
Thirty-nine percent of survey respondents identified cost as the largest barrier to recommending patients for CAR-T, whereas 37% indicated the logistics of administering CAR-T and following patients after infusion are too cumbersome.
More than half of respondents indicated additional financial resources and reimbursement are needed for patients, and that additional education is necessary for referring physicians.
“The slow approval process by payers is a big limitation,” Gajra said. “Those surveyed said speeding up the prior authorization and payer approval process would help increase CAR-T utilization.”
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Gajra A, et al. Abstract 4010. Presented at: ASH Annual Meeting and Exposition; Dec. 11-14, 2021.
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