Health care resource utilization (HCRU) and costs were greater for CAR-T therapy compared hematopoietic cell transplant (HCT) for diffuse large B-cell lymphoma (DLBCL), and cost offsets before and after the procedures provide useful insight for treatment planning, according to a study presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting.
These results were presented by Karl M. Kilgore, PhD, Avalere Health, An Inovalon Company, Towson, MD.
“Patients with relapsed/refractory [DLBCL] can be treated with 3 resource intense options: autologous HCT (auto-HCT), allogeneic HCT (allo-HCT), or anti-CD19 CAR-T therapy after 2 or more lines of systemic therapy,” said Dr Kilgore.
“The goal of this study is to use real world data to compare the patient characteristics, health care resource utilization, and costs in matched samples of patients who received 1 of these 3 treatments,” he continued.
Data was derived from the Center for Medicare and Medicaid Services (CMS) 100% Medicare Fee-for-Service (FFS) Part A and B claims data.
The study included 3 cohorts: CAR-T, auto-HCT, and allo-HCT. These cohorts were matched on baseline clinical characteristics using 1:1 propensity score matching with a caliper of 0.05. Patients who received auto-HCT or allo-HCT were assumed to be distinct populations offered at different lines of therapy, so researchers matched them to CAR-T patients separately.
Measures of HCRU were all-cause hospitalizations, outpatient, and emergency department (ED) visits. Costs were total paid amounts. HCRU and cost data were calculated for the 6 months pre- and post-index, but do not include utilization and costs associated with the index procedure itself.
The analysis comparing CAR-T and auto-HCT included 175 patients in each cohort. Utilization of auto-HCT was higher than CAR-T on all acute care hospitalization measures. Mean total medical costs were 35% higher ($85,382 vs $63,081, respectively) in the 6-month period before the index date.
After the index date, all measures were lower for both groups, including medical costs ($25,277 and $33,876, respectively). Researchers noted greater reductions in the auto-HCT group, resulting in lower utilization and costs than CAR-T therapy.
The analysis comparing CAR-T and allo-HCT included 142 patients in each cohort. Utilization of allo-HCT was higher than CAR-T on all pre-index date measures included cost ($92,119 and $70,105, respectively), with the exception of ED visits.
In the post-index period, lower costs ($34,477) and HCRU were reported for CAR-T, but costs remained stagnant for allo-HCT ($82,847).
“In summary while procedure costs were greater for CAR-T compared to HCT, systematic differences in [HCRU] and costs before and after the procedure yield cost offsets that provide useful insights for treatment planners and decisionmakers addressing the treatment challenges presented by relapsed/refractory DLBCL,” Dr Kilgore concluded.—Janelle Bradley
Mohammadi I, Purdum A, Wong AI, et al. Cost and Healthcare Utilization in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: A Real-World Analysis of Medicare Beneficiaries Receiving Chimeric Antigen Receptor T-Cell Vs. Autologous and Allogeneic Hematopoietic Cell Transplants. Presented at: the virtual 62nd ASH Annual Meeting and Exposition; December 5-8, 2020. Abstract 2500.
