The cost of treating AE due to treatment with CAR-T cell therapy

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Two posters presented at AMCP Nexus 2021 analyzed the cost of cytokine release syndrome treatment and neurological events, two common adverse events (AEs) of T cell chimeric antigen receptor (CAR) therapy.

T-cell therapies with chimeric antigen receptors (CAR) such as tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (aix-cel) have greatly improved outcomes in patients with diseases such as diffuse large B-cell lymphoma (DLBCL). However, these therapies are not without adverse events (AEs) and additional costs related to the use of health resources (HRU). Two recent posters presented at the AMCP Nexus 2021 examined the cost of these AEs.

The first poster summarized information from 4 real evidence studies on tisa-cel and axi-cel in order to quantify the associated costs. 1 UE management and analyzed costs included outpatient (OP), inpatient (IP) and intensive care (ICU)) Visits as well as pharmacy services.

In the 4 studies (published in 2019 and 2020), between 1% and 4% of patients receiving Tisa-cel and between 7% and 16% of patients receiving Axi-cel developed cytokine release syndrome ( CRS) grade ≥ 3. Grade ≥ 3 neurotoxicity events occurred between 0% and 5% of patients receiving Tisa-cel and between 20% and 35% of patients receiving Axi-cel.

Up to 20% of patients on Tisa-cel and up to 71% of patients on Axi-cel used tocilizumab, which is used to treat CRS. As other studies have shown, axi-cel was much more likely to be infused in the IP setting (92% -100%) compared to tisa-cel (36%), and the median days of hospital stay were higher for axi-cel (15 -16 days vs. 2 days). In the 28 days after the infusion, the median number of surgical visits for tisa-cel was 6 versus 4 for axi-cel.

While the median days in the intensive care unit were similar for the 2 therapies (4 days for tisa-cel and 5 days for axi-cel), only 7% of tisa-cel patients were transferred to the intensive care unit, compared with 28 to 38% of patients on axi-cel.

Overall, the costs for axi-cel were significantly higher than for tisa-cel:

  • $ 5,979 to $ 10,878 for the total estimated cost of treating patients for Axi-Cel versus $ 843 to $ 1962 for Tisa-Cel
  • $ 32,394 to $ 33,166 for the total estimated HRU cost per patient for Axi-Cel vs. $ 3,321 for Tisa-Cel

“The additional cost burden for axi-cel was mainly due to the increasing intensification and hospital stays due to a higher proportion of IP infusions among the [patients] Received from axi-cel, ”concluded the authors.

A second poster estimated the total patient cost for CRS and neurological events (NEs) for patients with large B-cell lymphoma (LBCL) treated with Axi-cel, Tisa-cel, or Lisocabtagene-maraleucel (Liso-cel). 2

The authors developed a model that included AEs of CRS and NE using data from the TRANSCEND NHL 001, ZUMA-1, and JULIET clinical studies. They found:

  1. The total weighted average cost per patient was $ 18,718 for Liso-Cel, $ 47,665 for Axi-Cel, and $ 42,538 for Tisa-Cel
  2. The weighted average CRS cost per patient was $ 8,213 for Liso-Cel, $ 20,442 for Axi-Cel, and $ 26,009 for Tisa-Cel
  3. The weighted average cost per patient per NE was $ 10,505 for Liso-Cel, $ 27,223 for Axi-Cel, and $ 16,528 for Tisa-Cel

The lower costs of potential CRS and NE management for Liso-Cel were due to the lower rates, according to the authors.

“These results highlight the economic impact of the differences in safety between CAR-T cell therapies,” the authors concluded.

References

1. Lim S., Bollu V, Dalal A, et al. Estimate the Cost of Adverse Events (AEs) and Health Resource Utilization (HRU) in Patients (pts) with Relapsed or Refractory Diffuse Large B-Cell Lymphoma (r / r DLBCL) receiving Tisagenlecleucel and Axicabtagene Cilloleucel in a real-world setting . Presented on: AMCP Nexus 2021; 18.-21. October 2021; Denver, Colorado. Summary C38.

2. Badaracco J, Keating S, Gitlin M. Updates to an economic model to estimate the cost of cytokine release syndrome (CRS) and neurological events (NE) with chimeric antigen receptor (CAR) T-cell therapies in patients (Pts) with relapsed or refractory (R / R) large b-cell lymphoma (LBCL). Presented on: AMCP Nexus 2021; 18.-21. October 2021; Denver, Colorado. Summary D13.


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