Medicare Patients Receiving Chimeric Antigen Receptor T-Cell Therapy for Non-Hodgkin Lymphoma: A Real-World Look at Patient Characteristics, Healthcare Utilization and Costs

Abstract

Introduction Historically, there have been limited curative treatment options for patients (pts) who relapse or have refractory Large B Cell Lymphoma (LBCL). Recently, autologous anti-CD19 chimeric antigen receptor T-Cell (CAR T) therapies were approved for the treatment of pts with relapsed or refractory LBCL after ≥ 2 prior systemic therapies. Objectives To describe the demographic and clinical characteristics of Medicare pts receiving CAR T therapy (axicabtagene ciloleucel or tisagenlecleucel), and compare healthcare utilization, costs, and outcomes pre- and post-CAR T therapy. Methods The study utilized a single-group pre-test/post-test design and Center for Medicare and Medicaid Services 100% Medicare Fee-for-Service (FFS) Part A & B claims data. (Part D has not been released.) Pts with LBCL, received CAR T therapy between 10/1/2017 and 9/30/2018, and were continuously enrolled in Medicare FFS for 6 months prior to and 100 days after CAR T infusion. Index episode of care was CAR T infusion and associated inpatient stay, if any. Baseline characteristics included age, gender, race, specific LBCL diagnosis, and comorbidities. Measures of utilization and cost pre- and post-CAR T were standardized as per patient per month (PPPM) to account for different follow-up durations, and included hospitalizations, intensive care unit (ICU) transfers, and emergency department (ED) visits. Pre- and post- CAR T statistical analyses excluded the index episode. Results 177 pts are included with an average age of 70 years; male (58.8%); white (87.6%); a primary diagnosis of diffuse LBCL (91.5%) and infrequent autologous stem cell transplant ( Pts spent a median of 16 days in hospital during their index episode of care and nearly half (45.5%) were transferred to ICU during their stay. During the 6-month pre-index period, over half the pts had ≥ 1 hospitalization, and nearly 20% had ≥3. Of these, 27.1% were re-admitted during the post-index period. For those hospitalized, the median length of stay (LOS) pre- and post-index was 7 and 5 days, respectively. The number of pts with an ED visit was reduced by half during post- vs. pre-index (15.8% vs. 29.9%). There was no evidence of subsequent intravenous outpatient during the 100-day post-index period although claims may lag for some pts. Exclusive of index episode costs, total healthcare costs during the pre-index period were $9,749 PPPM pre- vs. $7,121 post-index, a 27% decrease. Conclusions The results of this real-world study indicate that older pts with multiple comorbidities can be treated successfully with CAR T therapy, and that post-index care was associated with lower hospitalization rates, bed days, ED visits, and total costs.