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No Access to CAR-T Therapy Raises Mortality for Louisiana Medicaid Patients With DLBCL
A third of patients at a Louisiana medical center who were clinically eligible for chimeric antigen receptor T-cell (CAR-T) therapy for relapsed/refractory diffuse large B cell lymphoma (DLBCL) were prevented from accessing it because of insurance and associated costs, leading to increased mortality in the patients. Researchers reported their findings in a study abstract published in the Journal of Clinical Oncology.
“The state of Louisiana currently does not have any institution which offers CAR-T therapy. Our Medicaid population is further disadvantaged by the fact that their insurance does not cover out-of-state services,” explained a research team from LSU Health Shreveport, Shreveport, Louisiana. “Hence, we conducted this institutional study to evaluate the accessibility to CAR-T and the factors associated with it.”
The retrospective study included 84 adults with DLBCL treated at LSU Shreveport between January 2018 and December 2022. Among them, 17% were considered eligible for CAR-T therapy at relapse per clinician discretion.
However, 33% of eligible patients could not access the treatment because of factors including insurance status and costs associated with out-of-state living, according to the study. Consequently, there was an increased mortality of 60% in the cohort compared with 0% for patients who received referrals for CAR-T therapy.
Two-thirds of patients deemed clinically eligible but unable to access CAR-T therapy were covered by Medicaid, the study found.
“We aim to bring to light the disparity faced by Louisiana Medicaid patients wherein they don’t have access to a potentially curative therapy for DLBCL,” researchers wrote. “While we do recognize the expenses associated with CAR-T, we wish to highlight that not all states have direct access to this therapy. Seeing how our patients must already uproot their lives temporarily to get CAR-T, their decision could be made easier if insurance can cover the cost at least on a case-to-case basis.”
Reference:
Chennapragada SS, Amankwah M, Lerner JL, Shi R, Ramadas P. CAR-T therapy access with Louisiana Medicaid: a single institution retrospective analysis. Journal of Clinical Oncology. 2023;41(16 suppl):e18580-e18580. doi:10.1200/JCO.2023.41.16_suppl.e18580
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