ABCL-509 Healthcare Utilization and Costs in Chimeric Antigen Receptor T-Cell Therapy for B-Cell Lymphoma

Abstract

In depth analyses of healthcare utilization and costs associated with Anti-CD19 chimeric antigen receptor T-cell therapy (CAR19) for B-cell lymphoma are sparse. Here we describe the financial impact of CAR19 at The Ohio State University Wexner Medical Center. Sixty-three patients who received CAR19 at OSU from January 2018 through June 2019 were analyzed. Charges and costs were assessed on inpatient CAR T infusion encounters from date of infusion to date of discharge. For outpatient infusions, the CAR T administration encounter was analyzed; if admission occurred within 30 days of infusion for CAR T related events, that admission encounter was also analyzed. Cohort characteristics were comparable to previously reported real world studies. Forty-five patients who received axicabtagene ciloleucel (axi-cel) were significantly younger and had higher ferritin and LDH than 18 patients who received tisagenlecleucel (tisa-cel). For patients who received axi-cel, the median charges assessed were $176,535.20 (range: $30,977.4-$1,187,965.3) compared to $64,834.1 (range: $4,007.3-$429.380.0) for tisa-cel (p<.001). Axi-cel was associated with more toxicity and longer length of stay (LOS) than tisa-cel: 96% with cytokine release syndrome (CRS) vs. 44% (p<0.01); 73% with neurotoxicity vs. 22% (p<0.01), LOS 14 days vs. 9 days (p<0.001). Median follow-up was 31.4 months for axi-cel and 23.8 months for tisa-cel; progression free survival (PFS) and overall survival (OS) were not significantly different. Patients with Medicare based insurance were more likely to incur out of pocket costs compared to patients without Medicare (50% vs. 14.6%; p=.0061), with no significant differences in cost incurred ($1,364 vs. $807; p=0.44). Total operational loss incurred by OSU for the encounters analyzed was $1.734 million. For patients with Medicare plans, $2.565 million was lost, however for commercial plans the operational gain was $1.255 million. For Medicare, $2.489 million was lost on inpatient infusions and $76 thousand on outpatient infusions. We observed higher hospital charges, LOS, and toxicity with axi-cel compared to tisa-cel. Patients with Medicare more frequently incurred out of pocket costs and hospital losses were driven by inpatient infusions for patients with Medicare. More robust retrospective studies are needed to further investigate our findings.