A study presented at the 2020 ASH Annual Meeting found that chimeric antigen receptor (CAR) T-cell therapy resulted in less health care utilization, including fewer ambulatory visits and emergency department (ED) visits, as well as lower overall total health care costs compared with pre-CAR T-cell care.
Researchers evaluated in the Optum Research Database and included 109 adult commercial (70%) and Medicare Advantage (30%) enrollees with medical benefits and evidence of medical/procedure codes indicative of CAR T-cell therapy between Jan. 1, 2017, and March 31, 2019. Eligible patients had to be continuously enrolled in their commercial health care plan for at least three months prior to and six months after the infusion unless death occurred.
Measures of pre- and post-CAR T-cell health care resource utilization and standardized costs included ambulatory visits, ED visits, and inpatient admissions (both intensive care unit [ICU] and non-ICU visits).
Mean patient age was 59.31 years, 59% were male, and the mean Charlson Comorbidity Index was 3.60. Thirty patients received CAR T-cell administration through clinical trials; 17% received CAR T-cell therapy in a Prospective Payment System (PPS) Exempt Cancer Hospital, and 83% received treatment in inpatient PPS hospitals.
The CAR T-cell therapy index event was administered inpatient for 82% of patients, while 20 patients (18%) received CAR T-cell therapy in the outpatient setting. The median length of stay during CAR T-cell administration was 16 days.
During the pre-index period, all patients experienced an ambulatory visit with an average of 15.09 visits per-person, per-month (PPPM), whereas 41% had an ED encounter for an average rate of 0.39 visits PPPM, and 44% had an inpatient stay with 0.28 PPPM. Total medical and pharmacy costs were $128,000 PPPM.
After a median follow-up of 8.4 months, patients experienced 46% fewer ambulatory visits (average 8.14 PPPM; P<0.001), 49% fewer ED visits (average 0.20 PPPM; P<0.037), and 18% fewer inpatient visit rates (average 0.23 PPPM; P=0.415) after receiving CAR T-cell therapy. The mean total medical and pharmacy costs were 49% lower post-CAR T-cell treatment, at $66,000 PPPM (P<0.008).
Purdum A, JohnsonJ, Bonagura A, et al. The First Retrospective Commercial Claims-Based Analysis of CAR T Treated Patients with Relapsed or Refractory Large B-Cell Lymphoma (R/R LBCL). Abstract 1224. Presented at the 62nd American Society of Hematology Annual Meeting & Exposition, Dec. 2-11, 2020.