Delays in CAR T-Cell Treatment Cost Patients, Society

August 30, 2019

Delays in CAR T-cell therapy may significantly decrease gains in survival and productivity for patients with diffuse large B-cell lymphoma and pediatric acute lymphoblastic leukemia.

CAR T-cell therapy could provide significant benefits to patients and society through both gains in survival and productivity. However, the value that CAR T-cell therapy might bring to both may be limited by treatment delays, according to a study published in the American Journal of Managed Care.

Although estimates varied by production costs, Julia Thornton Snider, PhD, of Precision Health Economics, and colleagues estimated that a one-month CAR T-cell treatment delay could deplete societal value by almost 5% for patients with diffuse large B-cell lymphoma (DLBCL) and almost 10% for patients with pediatric acute lymphoblastic leukemia (pALL).

“Our social value analysis indicates that facilitating timely patient access is a key consideration in determining an optimal financing approach,” the researchers wrote. “For patients with rapidly progressing cancer and high mortality rates, delaying treatment comes at a high cost.”

In their analysis, Snider and colleagues used an economic framework for therapy valuation and measured social value as the sum of consumer surplus and manufacturer profit. Additionally, they estimated patient value as the value of additional quality-adjusted- life-years gained with CAR T-cell therapy, minus the incremental cost of CAR T-cell therapy compared with standard of care.

Depending on the production costs of manufacturers, as much as $6.5 billion in societal value was generated for patients with pALL and as much as $34.8 billion for patients with DLBCL. Loss of social value though increased with increasing delays in CAR T-cell therapy. Assuming production costs of $200,000, patients with pALL lost 36.2% of social value at 2 months delay and 67.3% at 6 months of treatment delay. Similarly, patients with DLCBL lost 11.5% of social value at 2 months and 46.0% of value at 6 months delay.

Bruce Levine, PhD, of Abramson Cancer Center at University of Pennsylvania in Philadelphia, said these results were interesting and highlighted that treatment delays, for whatever reason, impact the magnitude of the patient, company, and social benefit. Additionally, the loss of value estimated did not include impact on caregivers, which can be significant, especially for pediatric patients.

Levine did question some of the cost calculations for the study. Specifically, he said that the stem cell costs for CAR T for tisagenlecleucel in pediatric ALL were overestimated, as only very few patients proceed to transplant. In addition, he did not understand why future costs of the comparator were higher for axicabtagene compared with tisagenlecleucel.

“A key takeaway is that new cell and gene therapy products ‘present a challenge to existing payment systems because their costs accrue up front, whereas benefits accrue over a lifetime, in contrast with other cancer therapies that are administered over an extended time period,’” Levine quoted from the study. “The multi-payer U.S. system may be at a disadvantage in terms of built in incentives or disincentives to acclimate to these new types of therapies.”