For Relapsed or Refractory Diffuse Large B-cell Lymphoma, Tisa-cel Resulted in Lower Inpatient Health Care Resource Utilization and Non-CAR-T Costs Than Axi-cel

Few trials have compared the cost, health care resource utilization (HRU), and adverse events (AEs) of chimeric antigen receptor T-cell (CAR-T) therapies for relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) in the United States. To fill this knowledge gap, researchers at Oregon Health and Science University (OHSU) identified adults with DLBCL who received axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) and whose health care data had been collected in the Premier Healthcare Database from 2017 to 2020. The team then compared non-CAR-T costs, HRU, and AE rates between these 2 treatment cohorts during infusion and follow-up (Leukemia Lymphoma. 2022. Apr 14;1-11. doi:10.1080/10428194.2022.2060503).

The database held health records from more than 1000 contributing U.S. hospitals and affiliated outpatient facilities and roughly 231 million unique patients. The study period was the time elapsed from the index date to the end of data availability. The index date was defined as the admission date for the inpatient infusion or the infusion date for the outpatient infusion of CAR-T therapy.

The retrospective study included 119 patients, 33 of whom received tisa-cel and 86 of whom received axi-cel. “To our knowledge, it is the first study to assess HRU and provider costs associated with tisa-cel and axi-cel in a real-world setting during both the infusion encounter and the period following (and including) infusion,” wrote Richard Maziarz, MD, Center for Hematologic Malignancies and Knight Cancer Institute, OHSU, Portland, OR, and colleagues.

Patient characteristics were similar for the 2 treatment cohorts. However, the cohort who received tisa-cel had higher rates of comorbidities, particularly hypertension, diabetes, and renal disease, than the axi-cel cohort. The mean age of the patients was 62.3 years in the tisa-cel cohort and 59.8 years in the axi-cel cohort, and both cohorts consisted primarily of White men. Whereas 86% of the patients who received tisa-cel received it as an inpatient infusion, all who received axi-cel received it as an inpatient infusion.

The researchers found that tisa-cel was associated with shorter mean inpatient length of stay (LOS) than axi-cel during infusion and follow-up. Whereas LOS during infusion with tisa-cel was 11.3 days, LOS during infusion with axi-cel was 18.3 days. Similarly, during follow-up, LOS with tisa-cel was 3.9 days/month vs. 6.9 days/month with axi-cel.

“[C]ompared with axi-cel, tisa-cel was associated with significantly fewer inpatient admissions and significantly shorter LOS during both the infusion and follow-up periods,” wrote Dr. Maziarz and colleagues. “Lower inpatient HRU associated with tisa-cel vs. axi-cel led to substantially lower non-CAR-T-related healthcare costs during both the infusion encounter and follow-up period.” 

Whereas non-CAR-T costs during infusion were $27,595 with tisa-cel, they were $51,378 with axi-cel (P<.05). Similarly, monthly costs during follow-up were $28,777 with tisa-cel vs. $46,576 with axi-cel (P<.05). However, both CAR-T therapies resulted in similar rates of AEs and AE treatments.

“Future research with a larger patient population in a non-hospital-based database would help confirm these findings,” Dr Maziarz and colleagues concluded.