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Di Staso R, Casadei B, Gentilini M, Guadagnuolo S, Pellegrini C, Broccoli A, Gori D, Masetti R, Stefoni V, Bonifazi F, Zinzani PL, Argnani L. Economic evaluation of anti-CD19 CAR T-cell pathway for large B-cell lymphomas in the real-life setting: the experience of an Italian hub center in the first three years of activity. Ann Hematol 2024; 103:2499-2509. [PMID: 38695872 PMCID: PMC11224113 DOI: 10.1007/s00277-024-05766-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 07/06/2024]
Abstract
Poor literature report actual and detailed costs of chimeric antigen receptor (CAR) T-cell pathway in a real-life setting. We retrospectively collect data for all patients with relapsed/refractory aggressive large B-cell lymphoma who underwent leukapheresis between August 2019 and August 2022. All costs and medical resource consumption accountability were calculated on an intention-to-treat (ITT) basis, starting from leukapheresis to the time when the patient (infused or not) exited the CAR T-cell pathway for any reason. Eighty patients were addressed to leukapheresis and 59 were finally infused. After excluding CAR-T product cost, the main driver of higher costs were hospitalizations followed by the examinations/procedures and other drugs, respectively 43.9%, 26.3% and 25.4% of the total. Regarding costs of drugs and medications other than CAR T products, the most expensive items are those referred to AEs, both infective and extra-infective within 30 days from infusion, that account for 63% of the total. Density plot of cost analyses did not show any statistically significant difference with respect to the years of leukapheresis or infusion. To achieve finally 59/80 infused patients the per capita patients without CAR-T products results 74,000 euros. This analysis covers a growing concern on health systems, the burden of expenses related to CAR T-cell therapy, which appears to provide significant clinical benefit despite its high cost, thus making economic evaluations highly relevant. The relevance of this study should be also viewed in light of continuously evolving indications for this therapy.
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Affiliation(s)
- Rossana Di Staso
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Università Di Bologna, Via Massarenti, 9-40138, Bologna, Italy
| | - Beatrice Casadei
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
| | - Marianna Gentilini
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Università Di Bologna, Via Massarenti, 9-40138, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
| | - Serafina Guadagnuolo
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
| | - Cinzia Pellegrini
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
| | - Alessandro Broccoli
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Università Di Bologna, Via Massarenti, 9-40138, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
| | - Davide Gori
- Dipartimento Di Scienze Biomediche E Neuromotorie (DIBINEM), Università Di Bologna, Bologna, Italy
| | - Riccardo Masetti
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Università Di Bologna, Via Massarenti, 9-40138, Bologna, Italy
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Vittorio Stefoni
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Università Di Bologna, Via Massarenti, 9-40138, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
| | | | - Pier Luigi Zinzani
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Università Di Bologna, Via Massarenti, 9-40138, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
| | - Lisa Argnani
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Università Di Bologna, Via Massarenti, 9-40138, Bologna, Italy.
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Hoover A, Reimche P, Watson D, Tanner L, Gilchrist L, Finch M, Messinger YH, Turcotte LM. Healthcare cost and utilization for chimeric antigen receptor (CAR) T-cell therapy in the treatment of pediatric acute lymphoblastic leukemia: A commercial insurance claims database analysis. Cancer Rep (Hoboken) 2024; 7:e1980. [PMID: 38217445 PMCID: PMC10884615 DOI: 10.1002/cnr2.1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND B-lineage acute lymphoblastic leukemia (B-ALL) is the most common malignancy of childhood. With the introduction of novel cellular therapies, cost of care is a critical component and the financial burden experienced by patients and society requires evaluation. AIMS This study aims to assess the utilization and cost of care for chimeric antigen receptor T-cell (CAR-T) therapy for pediatric ALL patients with commercial insurance coverage in the United States. METHODS AND RESULTS Using de-identified commercial insurance data from the OptumLabs® Data Warehouse, a cohort of 37 patients, aged 1-25 years, with B-ALL treated with CAR-T therapy between Oct 2016 and Dec 2021 in the United States was identified. Cost was evaluated for a 90 day period encompassing CAR-T infusion and by administration and complication characteristics. Among the 37 identified B-ALL patients that received a CAR-T product infusion, 14 patients were female, median age at administration was 13 years. The median 90-day total cost was $620,500 (Mean: $589,108). Inpatient cost accounted for approximately 71% of the total cost with an average of 28 inpatient days per patient. Although inpatient cost was slightly higher in the older age group (aged 10-25 years) and in patients with a code for cytokine release syndrome (CRS), these differences were not statistically significant. CONCLUSION This real-world cost analysis shows for the first time the encompassing cost of CAR-T therapy for pediatric B-ALL patients in the US with commercial insurance. This study provides a valuable benchmark that can be used to analyze the financial implications of CAR-T therapy for pediatric B-ALL therapy on health systems.
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Affiliation(s)
- Alex Hoover
- Optum Labs Visiting Fellow, Department of PediatricsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Paige Reimche
- Department of PediatricsChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Dave Watson
- Department of PediatricsChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Lynn Tanner
- Department of PediatricsChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Laura Gilchrist
- Department of PediatricsChildren's MinnesotaMinneapolisMinnesotaUSA
- Graduate College, Division of Physical TherapySt. Catherine UniversitySt. PaulMinnesotaUSA
| | - Mike Finch
- Department of PediatricsChildren's MinnesotaMinneapolisMinnesotaUSA
| | | | - Lucie M. Turcotte
- Optum Labs Visiting Fellow, Department of PediatricsUniversity of MinnesotaMinneapolisMinnesotaUSA
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Foglia E, Garagiola E, Ladisa V, Rambaldi A, Cairoli R, Sammassimo S, Salè EO, Zinzani PL, Esposti M, Alberti L, Mulas MF, Melis E, Onnis S, Marcias M, Satta V, Croce D. Multidimensional Results and Reflections on CAR-T: The Italian Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3830. [PMID: 36900841 PMCID: PMC10001656 DOI: 10.3390/ijerph20053830] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
The present study aims at defining the economic and organizational impacts of the introduction of chimeric antigen receptor T-cell therapy (CAR-T) in Italy, for the management of diffuse large B-cell lymphoma (DLBCL) patients in third-line therapy, defining the overall level of sustainability for both hospitals and the National Healthcare System (NHS). The analysis focused on CAR-T and Best Salvage Care (in the following BSC), assuming the Italian hospital and NHS perspectives, over a 36-month time horizon. Process mapping and activity-based costing methodologies were applied to collect the hospital costs related to the BSC and CAR-T pathways, including adverse event management. Anonymous administrative data on services provided (diagnostic and laboratory examinations, hospitalizations, outpatient procedures, and therapies) to 47 third-line patients with lymphoma, as well as any organizational investments required, were collected, in two different Italian Hospitals. The economic results showed that the BSC clinical pathway required less resources in comparison with CAR-T (excluding the cost related to the therapy) (BSC: 29,558.41 vs. CAR-T: EUR 71,220.84, -58.5%). The budget impact analysis depicts that the introduction of CAR-T would generate an increase in costs ranging from 15% to 23%, without considering treatment costs. The assessment of the organizational impact reveals that the introduction of CAR-T therapy would require additional investments equal to a minimum of EUR 15,500 to a maximum of EUR 100,897.49, from the hospital perspective. Results show new economic evidence for healthcare decision makers, to optimize the appropriateness of resource allocation. The present analysis suggests the need to introduce a specific reimbursement tariff, both at the hospital and at NHS levels, since no consensus exists, at least in the Italian setting, concerning the proper remuneration for the hospitals who guarantee this innovative pathway, assuming high risks related to timely management of adverse events.
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Affiliation(s)
- Emanuela Foglia
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, 21053 Castellanza, Italy
| | - Elisabetta Garagiola
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, 21053 Castellanza, Italy
| | - Vito Ladisa
- Hospital Pharmacy, IRCCS National Cancer Institute Foundation, 20133 Milan, Italy
| | - Alessandro Rambaldi
- Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Roberto Cairoli
- Division of Hematology, Grande Ospedale Metropolitano Niguarda Hospital, 20162 Milano, Italy
| | - Simona Sammassimo
- Department of Oncology and Hematology-Oncology, European Institute of Oncology, 20141 Milan, Italy
| | | | - Pier Luigi Zinzani
- Institute of Hematology “Seragnoli”, IRCCS University Hospital of Bologna, 40139 Bologna, Italy
- Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, 40139 Bologna, Italy
| | - Marco Esposti
- Management Control, Lodi Hospital, 26900 Lodi, Italy
| | - Luisa Alberti
- Territorial Pharmaceutical Complex Structure, Regional Health Authority—ARES Sardinia, 09047 Cagliari, Italy
| | | | - Eleonora Melis
- Complex Structure for Planning and Management Control, Regional Health Authority—ARES Sardinia, 07100 Sassari, Italy
| | - Stefania Onnis
- Territorial District 3—Quartu Parteolla, Local Healthcare Authority—ASL 8, 09126 Cagliari, Italy
| | - Maurizio Marcias
- Complex Structure of Pharmacoeconomics and Pharmacovigilance, Regional Health Authority—ARES Sardinia, 09047 Cagliari, Italy
| | - Vittorio Satta
- Complex Structure Health Technology Assessment, Regional Health Authority—ARES Sardinia, 09047 Cagliari, Italy
| | - Davide Croce
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, 21053 Castellanza, Italy
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