Real-world data on healthcare costs associated with CAR-T therapies for non-Hodgkin lymphoma
Avalere Health (DC, USA) researchers have conducted a retrospective, real-world observational study assessing the healthcare utilization, costs and outcomes of non-Hodgkin lymphoma patients receiving chimeric antigen receptor T-cell (CAR-T) therapies.
Approximately 25,000 individuals are diagnosed with diffuse large B-cell lymphoma (DLBCL) each year in the USA. In 2017, the US FDA approved two autologous, anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapies for some relapsed or refractory DLBCL patients. Now, investigators from Avalere Health (DC, USA), Kite Pharma (CA, USA) and the Memorial Sloan Kettering Cancer Center (NY, USA) have described the demographic characteristics of Medicare beneficiaries receiving CAR-T therapies for DLBCL, and associated healthcare utilization, costs and outcomes pre- and post-therapy delivery.
Axicabtagene ciloleucel (Yescarta) and Tisagenlecleucel (Kymriah) are two CAR-T therapies approved for use in relapsed or refractory DLBCL patients who have received more than 2 years of prior systemic therapies. In this investigation, researchers employed a single-group, pre- and post-test study design using data from the Center for Medicare and Medicaid Services (MD, USA) 100% Medicare Fee-for-Service Part A and B claims database.
To allow comparisons of pre- and post-CAR-T therapy commencement periods – defined by patients initial CAR-T therapy infusions – patients included in the study were required to have been continuously enrolled in the Medicare Fee-for-Service scheme for a minimum of 6 months prior to therapy administration, as well as for at least 100 days post-therapy delivery.
Analysis of data pertaining to 177 eligible patients demonstrated the median age of DLBCL patients receiving CAR-T therapies to be 71; more than 50% of the study participants also had at least one chronic condition, which may have excluded them from clinical trial enrolment.
In the 6 months immediately prior to CAR-T delivery, over 50% of study participants had been hospitalized at least once, with an average hospital stay of 7 days. By contrast, post-CAR-T therapy delivery, patients mean length of hospital stay was 5 days.
Researchers also observed that, in the 6 months prior to CAR-T delivery, the number of patients with recorded emergency department visits was 29.9%; this fell significantly post-therapy delivery to only 15.8%.
Further, excluding costs directly associated with therapy delivery, average monthly healthcare costs per patient, prior to CAR-T therapy administration, were US$9749. By contrast, following CAR-T delivery, monthly mean healthcare costs dropped to US$7121 per patient; this is equivalent to a 27% reduction in healthcare costs.
The study authors concluded: “The results of this real-world study indicate that older patients with multiple comorbidities can be treated successfully with CAR-T therapy, and that post-index care was associated with lower hospitalization rates, bed days, [emergency department] visits and lower total costs during this period.”
Kilgore KM, Mohammadi I, Schroeder A. Medicare patients receiving chimeric antigen receptor T-cell therapy for non-Hodgkin lymphoma: a first real-world look at patient characteristics, healthcare utilization and costs. Program and Abstracts of the 61st annual meeting of the American Society of Hematology. Orlando, FL, USA, 7–10 December 2019 (Poster 793);