CAR-T therapy is becoming a more frequent treatment for Medicare patients with diffuse large B-cell lymphoma, but changes in CAR-T treatments that push it as an earlier line of therapy may change where patients receive the therapy — and ultimately, its cost.
In a study published June 25 in Advances in Therapy, researchers concluded it costs significantly more for patients to be treated with CAR-T therapy in the hospital setting compared to outside of it.
Researchers from Kite Pharma and ADVI Health analyzed 391 Medicare claims from patients who received CAR-T therapy between 2021 and 2022 and evaluated the costs and outcomes of patients treated in hospital versus outpatient care.
"Since the FDA's approval of the first CAR-T product, there have been many discussions focused on manufacturing costs, market dynamics, and patient access to innovative therapies," the authors wrote. "For example, adjustments in Medicare payments has impacted hospital [inpatient] reimbursements for CAR-T therapies. These changes are part of a broader discussion regarding cost compared to traditional treatments, which is confounded by the changing treatment paradigm as CAR-T moves into earlier lines of therapy."
Of the 391 claims, 79% of patients received CAR-T therapy in the hospital, and only 21% received it in an outpatient setting. The average price tag for receiving the therapy in the hospital was $498,723 compared to $414,393 outside of the hospital — a difference of $84,330.
The total cost of CAR-T therapy for inpatient care ranged between $276,138 and $1,066,524, and for outpatient care it was between $276,980 and $849,878.
However, 59% of patients who were treated with CAR-T therapy outside the hospital were more likely to be readmitted to the hospital, whereas only 21% of patients treated in a hospital with the therapy returned.
"The data show that the average cost received by hospitals encompasses the expenses related to both the CAR-T drug and the medical services delivered to patients," the authors wrote.