While the efficacy of chimeric antigen receptor (CAR) T-cell therapy is well established, the comparative hospital system costs and health care resource utilization (HRU) for CAR T-cell therapy and stem cell transplant (SCT) in patients with large B-cell lymphoma (LBCL) remain unclear and are largely based on cost-charge ratio estimates.

The first study to examine actuarial cost and HRU with most recent real-world use of CAR T and SCT using the hospital system perspective, "Hospital costs and health care resource utilization for chimeric antigen (CAR) T-cell therapy and stem cell transplant in patients with large B-cell lymphoma in the United States," was presented by Gunjan L Shah, MD, and colleagues at the 64th American Society of Hematology Annual Meeting and Exposition.

Inclusion criteria consisted of adult patients who had an inpatient or outpatient visit between January 1, 2017, and April 30, 2021, with CAR T-cell infusion or SCT transfusion for the treatment of LBCL (principal or secondary discharge ICD-10-CM diagnosis codes: C83.3x, C85.1x, C85.2x, C85.8x, C83.8x, and C83.9x). Exclusion criteria consisted of patients who had two or more CAR T-cell and/or SCT infusions, or was based on continuous data not being available by the treating hospital during the 365-day preprocedure and 180-day follow-up periods. The infusion visit was considered to be the index event.

A total of 852 patients (208 CAR T; 595 auto-SCT; 49 allo-SCT) were treated at 37 hospital systems across the United States. There was a mean patient age of 60 years (SD = 12; median = 62; 39.6% ≥65 years). Health care coverage consisted of commercial (43.9%), Medicare (36.3%), Medicaid (11.6%), and other (8.2%). Patient characteristics were similar across procedure types and there was no noticeable difference in hospital teaching status or size between CAR T-cell therapy and SCT patient groups.

The most common comorbidities were diabetes (17.6%), chronic pulmonary disease (9.2%), and renal disease (6.6%).

The total mean cost of index procedure for CAR T, auto-SCT, and allo-SCT was $371,136, $96,515, and $169,269 (P <.001). The mean index nonpharmacy cost, however, for CAR T was lower compared to SCT (mean $41,375 CAR T, $51,778 auto-SCT, $111,594 allo-SCT; P <0.001).

Dr Shah explained that “the index data itself mostly occurred in the inpatient setting in this data set. So, for the vast majority of infusions, over 90% for all three groups were done in the inpatient setting, and obviously some of this data, we would expect to be able to use to figure out outpatient procedures as well, but it was very small.”

The average length of stay for inpatient-treated patients was shorter for CAR T-cell therapy than auto-SCT or allo-SCT (mean [median]: 18[15] days CAR T; 21[20] days auto-SCT; 28[26] days allo-SCT; P <.001).

“The [intensive care unit (ICU)] admission rate and length of stay is variable over time as this was very early on in the CAR T-cell commercial era and so it’s a little bit harder of a comparison,” Dr Shah presented, “though it does seem like, potentially over time, there is less ICU use for the CAR T-cell patients.”

The researchers noted that even though CAR T-cell–treated patients incurred higher upfront pharmacy costs to hospitals compared to SCT, there were nonpharmacy cost offsets and lower HRU burdens overall to hospital system.

“The idea behind this study is not necessarily to compare across cellular therapies in the sense of clinically,” Dr Shah concluded, “but to really set benchmarks and help programs who are getting started and potentially used for contracting purposes with the different insurance companies or are planning on how to increase access and start new programs.”

The researchers also emphasized that their results should be interpreted with caution as they may not reflect HRU and costs to hospitals not included in the health care database.

Cui C, Feng C, Rosenthal N. Hospital costs and health care resource utilization for chimeric antigen T-cell therapy and stem cell transplant in patients with large B-cell lymphoma in the United States. Presented at the 64th ASH Annual Meeting and Exposition. December 10-13, 2022. Abstract 892. Funded by Kite.