PCN167 Estimation of the Financial Impact of Chimeric Antigen Receptor (CAR) T-Cell Therapy for French Hospitals

Abstract

CAR T-cell therapy, a potentially revolutionary treatment for diffuse large B-cell lymphoma (DLBCL), comprises a multistep process that requires specific patient monitoring and hospital resource mobilization. In France, funding of CAR T-cell therapy currently relies on existing disease-specific diagnosis-related groups (DRGs), similar to those used for hospital stays unrelated to CAR T-cell therapy, and includes a fixed sum of €15,000 for the first 400 patients. These DRGs may be insufficient to capture the true costs of these novel therapies. We estimated the financial impact, excluding drug cost, of administering CAR T-cell therapy for French hospitals. The patient pathway for CAR T-cell therapy includes 6 steps: eligibility assessment, leukapheresis, bridging chemotherapy, lymphodepleting chemotherapy, CAR T-cell infusion, and patient follow-up. We identified the healthcare resources required for each step, valued those resources from the perspectives of the hospital and the national health insurance, and then calculated the financial impact of CAR T-cell therapy as the difference between the 2 perspectives. Our base-case analysis was modeled on 1 experienced CAR T-cell therapy center primarily administering approved CAR T-cell therapies, which outsourced some aspects of care to its local hospital network. Scenarios for alternative patient management were also considered. In the base-case analysis, the cost of CAR T-cell therapy administration for patients with DLBCL was estimated at €42,398 from the hospital perspective and €22,857 from the national health insurance perspective, resulting in a €19,540 loss per patient for the CAR T-cell therapy administration hospital. Alternative scenarios resulted in financial losses of €18,347 to €20,722 per patient. With estimated losses of €18,347 to €20,722 per patient, CAR T-cell therapy administration is expected to have a significant impact on hospital finances. Our results indicate that the DRG fixed sum is insufficient to support the implementation of CAR T-cell therapy in French hospitals.