Healthcare resource use (HRU) by infusion setting of chimeric antigen receptor T-cell (CAR-T) in patients with relapsed and refractory (r/r) diffuse large B-cell lymphoma (DLBCL): A retrospective cohort study using CMS 100% Medicare database.

Abstract

e19550 Background: Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are CAR-T therapies that were approved for r/r DLBCL in 2017 and 2018, respectively. While majority of the CAR-T infusions occur at inpatient (IP) setting in clinical trials, CAR-T infusions can also occur in the outpatient (OP) setting. This study aimed to compare the real-world HRU between IP vs. OP infusion of CAR-T among patients with r/r DLBCL. Methods: Adult patients with r/r DLBCL receiving tisa-cel or axi-cel were selected from the CMS 100% Medicare data from 2017 to 2019 and classified into IP and OP cohorts based on CAR-T infusion setting. Number of IP, OP, intensive care unit (ICU) visits, IP days, and ICU days by month post-CAR-T infusion were compared between cohorts using generalized linear models, adjusting for age, sex, race, and National Cancer Institute comorbidity index. Average length of stay (LOS) per IP episode during the first month was also described. Results: A total of 430 patients receiving CAR-T (380 IP and 50 OP) were identified. Among those with CAR-T regimen identifiable in the OP cohort, 90.2% received tisa-cel and 9.8% received axi-cel. Mean age at CAR-T infusion in IP and OP cohorts was 70.8 and 68.4 years, respectively. Most of the CAR-T infusions occurred in 2019 (66.6% in IP cohort and 74.0% in OP cohort). During the first month post-CAR-T infusion, OP cohort had significantly lower number of IP visits, IP days, ICU stays, and ICU days compared to the IP cohort. Average LOS per IP episode was 14.2 days in the IP cohort and 7.1 days in the OP cohort. Number of IP visits, IP days, and ICU days were nominally lower while number of OP visits were nominally higher in the OP cohort compared to the IP cohort in subsequent months (Table). Conclusions: Over 90% of the patients treated with CAR-T in the OP setting received tisa-cel. Patients receiving CAR-T in the OP setting had lower resource use of IP and ICU compared to patients receiving CAR-T in the IP setting.[Table: see text]