Chimeric antigen receptor (CAR) T-cell therapy is now approved as third-line treatment for patients with B-cell lymphomas and leukemias. For some patients, CAR T-cell therapy is a miracle therapy, extending survival and, in some cases, as a bridge to a potentially curative transplant. But at an estimated cost of $375,000 to $475,000 per person, many people have questioned the value of this treatment, and whether it can be delivered effectively to patients not enrolled in clinical trials.
Based on real-world Medicare claims data for adults with lymphoma who received CAR T-cell therapy from 2017 to 2018, results of a new study showed that this type of treatment can be used in settings outside of clinical trials, and it is associated with reduced costs of treatment after the use of CAR T-cell therapy. In fact, the overall cost of medical care, exclusive of CAR T-cell therapy, was reduced by more than 33% 6 months after treatment compared with 6 months before CAR T-cell therapy. These study results were presented at ASH 2019 by lead investigator Karl M. Kilgore, PhD, Senior Research Scientist, Avalere Health, Bowie, MD.
“This is the first real-world look at use of CAR T-cell therapy. These data from a Medicare claims database reflect very early experience with CAR T-cells and show that in older adults with lymphoma, CAR T-cell therapy was associated with fewer hospitalizations, shorter time in hospital, fewer emergency department visits, and lower total healthcare costs,” said Dr Kilgore.
“A key take-home point is that older patients with multiple comorbidities can be successfully treated with CAR T-cells. Although this is not a randomized clinical trial, the data could make the case for older and sicker patients to get CAR T-cells,” Dr Kilgore said.
The study included Medicare claims for patients with lymphoma who received CAR T-cell therapy between October 2017 and September 2018. A total of 207 patients with diffuse large B-cell lymphoma (DLBCL) were enrolled in Medicare at least 6 months before and 6 months after their CAR T-cell therapy. A total of 91% of patients had a primary diagnosis of DLBCL (median age, 71 years; approximately 60% were male).
The patients had many comorbidities; 74.6% had a Charlson Comorbidity Index score ≥2.78. More than half (51%) of the patients had ≥1 chronic conditions, such as heart failure, renal failure, and deep-vein thrombosis or pulmonary embolism, that would have excluded them from participation in clinical trials of CAR T-cell therapy.
Fewer than 5% of patients had a previous autologous stem-cell transplant, 52% of patients had received treatment with intravenous chemotherapy in the 6 months before their CAR T-cell therapy, and 60% received outpatient lymphodepletion.
CAR T-cell therapy is lifesaving for many patients; 6 months post–CAR T-cell therapy, 73% of patients were alive, and at 2 years, more than 50% were alive. The median overall survival had not been reached at the time of the ASH presentation. No deaths were reported in the 6 months after CAR T-cell therapy, but 5% of patients were admitted to hospice care.
Real-World Costs Before and After CAR T-Cell Therapy
For the 6 months after CAR T-cell therapy, the time in hospital was reduced by 17%, and emergency department visits were reduced by 33% compared with the 6-month period before receiving CAR T-cell therapy. The total number of emergency department visits was reduced by 50% in the 6 months after versus before CAR T-cell treatment (15.8% vs 29.9%).
Overall healthcare costs, exclusive of the cost of CAR T-cell therapy, were 39% lower in the 6 months after than the 6 months before CAR T-cell therapy.
The median total healthcare costs during the preindex period were $51,999 and $14,014 postindex. The per-patient per-month costs were $9749 before CAR T-cell therapy and $7121 after CAR T-cell therapy, representing a 27% decrease in expenditures.
The median length of hospital stay for the CAR T-cell therapy was 17 days. The median time in the intensive care unit (ICU) was 13 days, but fewer than 50% of patients required an ICU stay.
“The total amount paid for CAR T-cells from all sources varied significantly according to whether or not the patient was on a clinical trial, and whether or not the hospital was reimbursed under standard Medicare prospective payment services for inpatient facilities or through a prospective payment services–exempt payment system,” Dr Kilgore said. “The total cost of stay for the procedure was much higher in the prospective payment services hospitals.”