Costs, lengths of stay after CAR T-cell therapy greater for younger patients
Two studies presented at this year’s Transplantation & Cellular Therapy Meetings provided new insights into treatment costs and hospital stays associated with chimeric antigen receptor T-cell therapy.
The research from Vizient — a health care performance improvement company — showed adults who underwent CAR T-cell therapy required a median 15-day hospital stay, which resulted in a median total cost of $85,726 and median direct cost of $49,802.
Patients aged younger than 25 years required a longer hospital stay (median, 19 days), resulting in higher total costs (median, $242,730) and direct costs (median, $166,402).
In 2017, CMS assigned two unique ICD-10 procedure codes to CAR T-cell therapy, allowing its use to be tracked in Vizient’s Clinical Data Base.
The database — which includes patient information from more than 400 hospitals and approximately 95% of U.S. academic medical centers — included data on more than 1,200 patients who underwent CAR T-cell therapy.
“The database looks at real-world evidence,” Carina Dolan, PharmD, BCOP, director for clinical oncology and pharmaceutical outcomes at Vizient, told HemOnc Today. “In the arena of oncology, it’s nice to know what the trends are and what we’re seeing for in-patient average lengths and ICU stays. We don’t have a known benchmark, so it’s useful to aggregate these data and tabulate what we’re seeing in real-world evidence.”
More follow-up on these cohorts is necessary to firmly establish trends in outcomes following the procedures, according to Alyssa Hartsell Harris, MPH, lead analyst at Vizient, who presented the findings of both studies.
In addition, more effort is needed to track actual costs of treatment and adverse effects, including organ failure, neurologic complications and cytokine release syndrome, she said.
Follow-up studies are underway to refine by cancer indication, and to look at the total cost and outcomes of the full CAR-T episode beyond the scope of this study, which focused on the inpatient encounter for the CAR-T procedure itself.
“We’re excited about this type of aggregated data that provide our academic medical center members with macro insights into their work,” Dolan told HemOnc Today.
Trends among adults
One study focused on 1,186 patients aged 18 years or older (mean age, 58.7 years; 63.7% men) who underwent CAR T-cell therapy between May 2017 and December 2018.
The research looked at outcomes and costs associated with the encounter in which the CAR-T procedure was administered.
More than half (59.7%) of patients had diffuse large B-cell lymphoma, whereas 12.2% had another type of B-cell lymphoma, 11.6% had multiple myeloma, 4.3% had acute lymphoblastic leukemia and 1.4% had acute myeloid leukemia.
Thirty-one patients underwent two or more CAR T procedures.
Payer types included commercial (53%), Medicare (34.9%), Medicaid (5.1%) and other (6.1%).
Harris reported 52 (4.4%) in-hospital deaths, a median length of stay of 15 days (interquartile range [IQR], 11-21) and 203 (17.1%) 30-day unplanned readmissions. No patients required ICU transfer.
Two-thirds (66.9%) of patients experienced adverse effects due to immunotherapy. Common adverse events included fever (56.4%), change in blood pressure (50.3%), nausea (26.1%), sepsis or systemic inflammatory response syndrome (20.7%), headache or migraine (18.8%) and acute kidney failure (15.3%).
Vizient cost methodology, adapted from CMS cost reports, calculated median total cost of hospitalization of $85,726, with median direct costs of $49,802. The greatest contributor to total cost was the pharmacy service group (median share, $23,150; IQR, $4,258-$195,894).
“The Vizient cost methodology takes charges associated with the particular CAR T encounter and then applies a cost-to-charge ratio and applies a hospital-specific wage index to adjust for labor differences across the country,” Harris told HemOnc Today. “The cost-to-charge ratios are derived from each member’s CMS Medicare Cost Report, and from there we calculate an observed direct cost of the care provided.”
Young adults and children
Harris presented results of a second study that focused on 68 patients aged 25 years or younger (mean age, 16.3 years; 76.5% male) who underwent CAR T-cell therapy between October 2017 and December 2018.
Most patients had ALL (70.6%) or large B-cell lymphoma (22.1%). One patient (1.5%) had blastic natural killer-cell lymphoma, one patient (1.5%) had acute myoblastic lymphoma and three had another malignancy. Three patients underwent a second CAR T procedure an average of 114 days after the initial procedure.
Payer types included commercial (52.9%), Medicaid (32.4%) and other (14.7%).
Harris reported five (7.4%) in-hospital deaths and a median length of stay of 19 days. Thirteen patients (19.1%) required unplanned readmissions within 30 days.
Two-thirds (67.6%) of patients experienced adverse effects due to immunotherapy. Common adverse events included fever (45.6%), headache or migraine (32.3%), blood pressure change (32.3%), sepsis or systemic inflammatory response syndrome (27.9%) and acute kidney failure (19.1%).
Harris reported a $242,730 median total cost of hospitalization in this cohort, with a median $166,402 in direct costs. The greatest contributor to total cost was the pharmacy service group (median share, $167,585; IQR, $12,576-$337,921).
“There are protocols in place for adult patients that differ from those for pediatric patients that might account for some of the disparity in cost,” Dolan told HemOnc Today. “The length of stay was longer for younger patients, and pediatric resources might have been more resource-intensive. A major benefit of tabulating this level of real-world data is that we can help to identify trends in, for example, length of stay for pediatric patients, that Vizient members could utilize to gain important insights into their data, potentially standardize treatment protocols and to improve outcomes.” – by Joe Gramigna
Harris A. Poster 500. Presented at: Transplantation & Cellular Therapy Meetings; Feb. 20-24, 2019; Houston.
Harris A. Poster 501. Presented at: Transplantation & Cellular Therapy Meetings; Feb. 20-24, 2019; Houston.
For more information:
Alyssa Hartsell Harris, MPH, can be reached at firstname.lastname@example.org.
Carina Dolan, PharmD, BCOP, can be reached at email@example.com.
Disclosures: Harris and Dolan report no relevant financial disclosures.