Health Care Resource Utilization and Costs of CAR T Therapy in Patients with Large B-Cell Lymphoma: A Retrospective US Claims Database Analysis

Introduction: Despite its association with promising clinical outcomes, chimeric antigen receptor T-cell (CAR T) therapy may not be a feasible treatment option for some patients with relapsed or refractory large B-cell lymphoma (LBCL). Although more patients have been referred to CAR T therapy in recent years, many patients are still not treated due to anticipated costs and logistical challenges, particularly in the community setting (Gajra et al, Immunotherapy 2020). Because of long manufacturing times, patients often require bridging therapy prior to CAR T and a subset of patients die on bridging therapy without ever receiving CAR T (Chow et al, Am J Hematol 2020). Furthermore, more than one-half of patients relapse within 1 year of receiving CAR T therapy (Spiegel et al, Blood 2021). It is important to understand the clinical and economic burden associated with CAR T therapy. We assessed health care resource utilization (HCRU) and all-cause health care (medical and medication) costs from 30 days prior to through 90 days after infusion with tisagenlecleucel or axicabtagene ciloleucel CAR T therapy in patients with diffuse large B-cell lymphoma (DLBCL), the most common non-Hodgkin lymphoma (NHL) subtype, or primary mediastinal large B-cell lymphoma (PMBCL), another aggressive NHL subtype.

Methods: This observational, retrospective cohort study analyzed MarketScan (IBM, Armonk, NY) administrative claims data for adult patients with DLBCL and PMBCL who received CAR T infusion therapy between October 1, 2017 and March 31, 2021, and who had continuous enrollment 6 months before and at least 90 days after the CAR T treatment date (index date). Those with mantle cell lymphoma or follicular lymphoma were excluded. Hospital length of stay (LOS) and HCRU from 30-days prior to 90-days post-infusion for inpatient and outpatient hospital visits and other facility visits were examined. All-cause medical, medication, and health care costs per patient were reported in 2021 US dollars.

Results: A total of 106 patients (DLBCL, n=92; PMBCL, n=14) who received CAR T therapy (mean age, 55 years; men, 59%; commercial payer, 87%; CAR T brand information available, n=20 patients) were included in the analysis. A majority of patients (78 [74%]) had at least 5 outpatient hospital visits in the 30 days prior to CAR T therapy. Many were reported as having received bridging and/or lymphodepletion treatment prior to CAR T infusion (81 [76%]). CAR T therapy was administered in an inpatient setting for 92 patients (87%) with a mean (SD) LOS of 18.4 (11.3) days and a mean (SD) cost of $341,217 ($245,564) within 90 days. Among those receiving CAR T inpatient, 41 (45%) had intensive care unit (ICU) admissions during their stay. In the 90 days post-CAR T infusion, most patients (92 [87%]) had at least 5 outpatient hospital visits. Subsequent inpatient admissions occurred in 30 patients (28%), with a mean (SD) LOS of 12 (12.44) days and a mean (SD) cost of $83,952 ($105,961) within 90 days after CAR T infusion. From 30 days prior to 90 days after infusion, the mean (SD) total all-cause health care costs per patient, including those associated with CAR T therapy, were $511,139 ($293,631) (Figure).

Conclusions: While CAR T therapy may be a treatment option as LBCL patients progress, patients face a considerable clinical and economic burden. Both the HCRU prior to infusion and after infusion included frequent outpatient hospital visits. Additionally, in this analysis, inpatient hospitalizations were the primary driver of HCRU and costs of CAR T therapy. Most patients received CAR T therapy on an inpatient basis, requiring prolonged stays. Nearly half of patients were admitted to the ICU and more than a quarter experienced secondary inpatient stays. Costs associated with the logistically challenging CAR T therapy within a month leading up to the infusion and up to 3 months post-infusion are substantial, averaging half a million dollars per patient, indicating a significant burden, given that a majority of the patients relapse within a year. These findings underscore the need for an accessible, off-the-shelf, and efficacious therapeutic option for LBCL patients.

Davies:AbbVie: Current Employment. Kamalakar:AbbVie: Current Employment, Current equity holder in publicly-traded company. Yu:AbbVie: Current Employment, Current equity holder in publicly-traded company. Huang:AbbVie: Current Employment. Wang:AbbVie: Current Employment, Current equity holder in publicly-traded company. Sail:AbbVie: Current Employment, Current equity holder in publicly-traded company. Doerr:AbbVie: Current Employment, Current equity holder in publicly-traded company. Sharmokh:AbbVie: Current Employment. Mutebi:Genmab: Current Employment, Current equity holder in publicly-traded company. Salles:Roche/Genentech, Gilead Sciences, Janssen, Celgene, Novartis, MorphoSys AG, Epizyme, Alimera Sciences, Genmab, Debiopharm Group, Velosbio, Bristol-Myers Squibb, BeiGene, Incyte, Miltenyi Biotec, Ipsen, Kite, a Gilead Company, Loxo, Rapt: Consultancy; Roche/Genentech, Janssen, Celgene, Gilead Sciences, Novartis, AbbVie, MorphoSys AG, Amgen, Bayer, Epizyme, Regeneron, Kite, a Gilead Company: Honoraria; AbbVie, BeiGene, Bristol Myers Squibb, Celgene, Debiopharm, Epizyme, Genentech/Roche, Genmab, Incyte, Kite, a Gilead Company, Miltenyi, MorphoSys, Takeda, and VelosBio: Membership on an entity's Board of Directors or advisory committees.