Estimating the health care costs associated with receipt of lisocabtagene maraleucel: Insights from adults with mantle cell lymphoma (TRANSCEND NHL 001).

Abstract

7028 Background: Anti-CD19 CAR T cell therapy is a major advancement for treating R/R B-cell malignancies such as mantle cell lymphoma (MCL). While effective disease management with CAR T cell therapy is expected to reduce patients’ health care resource utilization (HCRU) over the long-term, few studies have examined the short-term impacts of this treatment on HCRU and associated health care costs. Here, we used data from the TRANSCEND NHL 001 (NCT02631044) clinical trial to estimate the HCRU-related costs incurred by patients with R/R MCL over the first 12 months after receipt of lisocabtagene maraleucel (liso-cel). Methods: A retrospective analysis of clinical trial data was conducted to calculate the frequency of HCRU (medications [excluding liso-cel], diagnostics, procedures, ICU and non-ICU hospitalizations) observed over the 12 months immediately after administration of liso-cel. Costs for each HCRU event were derived from public databases and literature, adjusted to 2023 United States (US) dollars, and used to estimate patient-level health care costs. Results: Of the patients treated (N = 88), 76.1% were male, 87.5% were White, and mean ± standard deviation (SD) age was 67.5 ± 9 years. All patients were treated in the US and completed a median (range) of 3 (1–11) prior lines of therapy before receiving liso-cel. Most patients (93.2%) received the recommended dose of 100 × 106 CAR+ T cells. The total mean ± SD per-patient cost (excluding liso-cel) was estimated at $138,413 ± $58,555 over 12 months. Facility use accounted for 77.7% of all costs, primarily owing to non-ICU hospitalizations (98.9%), which had a mean ± SD length of stay of 19.5 ± 16.7 days per eligible patient. Half of all health care costs were incurred within the first month of infusion (53.2%), with each subsequent month contributing a fraction (1.5%–6.3%) of total costs. A total of 13 out of 88 patients received their initial infusion in an outpatient setting and incurred 23% fewer costs compared with those who received their infusion in an inpatient setting ($110,050 vs $143,418), primarily as a function of reduced first-month facility use. Total costs for patients receiving liso-cel in outpatient settings were further reduced to $72,771 upon exclusion of 3 outliers. Conclusions: Non-ICU hospitalizations were the largest driver of liso-cel–related costs in this R/R MCL cohort of clinical trial participants. Most of the cost burden was incurred within 1 month of treatment, with dramatic reductions in HCRU and health care costs observed thereafter. Results suggest that treatment in the outpatient setting, even in part (eg, at initial infusion only), may confer substantial cost savings to the health care system.