Comparing Costs and HRU for Tisagenlecleucel vs Axicabtagene Ciloleucel for DLBCL

Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are chimeric antigen receptor (CAR) T-cell therapies approved by the FDA in 2017 and 2018, respectively, to treat diffuse large B-cell lymphoma (DLBCL). Two new posters evaluated the health care resource utilization (HRU) of the 2 therapies in the real world.

The first poster compared real-world HRU by setting.¹ The majority of CAR T-cell therapy infusions occur at inpatient (IP) settings in clinical trials, but they can also take place in the outpatient (OP) setting, the authors noted.

A total of 430 patients receiving axi-cel or tisa-cel were selected from the CMS 100% Medicare data from 2017 to 2019. Based on their CAR T-cell therapy infusion setting, they were classified into IP (n = 380) and OP (n = 50) cohorts. The majority (90.2%) of patients in the OP cohort received tisa-cel and 9.8% received axi-cel. The majority of patients were White (84.5% in IP and 96% in OP) and male (62.4% in IP and 70.0% in OP).

Compared with the IP cohort, patients in the OP cohort had a significantly lower number of IP visits during the first month post–CAR T infusion, as well as fewer IP visits, intensive care unit (ICU) stays, and ICU days. Length of stay (LOS) per IP episode was also shorter for the OP cohort (7.1 days) compared with the IP cohort (14.2 days).

“Patients receiving CAR-T in the OP setting had lower resource use of IP and ICU compared to patients receiving CAR-T in the IP setting,” the authors concluded.

In the second poster, the authors assessed HRU and costs for the same 2 CAR T-cell therapies in patients with DLBCL.² The costs, not included CAR T product cost, were compared at the CAR T-cell therapy infusion encounter and as per patient per month (PPPM) measures.

The study included 33 patients receiving tisa-cel and 86 patients receiving axi-cel. One-fourth (24.2%) of tisa-cel infusions occurred OP, while all axi-cel infusions occurred IP. Tisa-cel infusion was associated with 11.3 days of hospitalization compared with 18.3 days for axi-cel infusion. However, tisa-cel was associated with more OP visits compared with axi-cel (2.2 vs 1.2, respectively; P = .01).

The PPPM IP admission rate was 0.3 for tisa-cel and 0.5 for axi-cel (P = .12) and the PPPM LOS was 3.9 days for tisa-cel and 6.9 days for axi-cel (P = .03). There was no significant difference for PPPM ICU rate or ICU days.

The costs for tisa-cel were significantly lower than for axi-cel. At infusion encounter they were $27,594 for tisa-cel vs $51,378 for axicel (P < .01). During the follow-up (5.0 months for tisa-cel and 3.3 months for axi-cel), PPM costs were $28,777 for tisa-cel vs $46,575 for axi-cel (P < .05).

The authors suggested additional research is needed with a larger patient population.

References

1. Dalal A, Yang H, Zhao J, et al. Healthcare resource use (HRU) by infusion setting of chimeric antigen receptor T-cell (CAR-T) therapy in patients with diffuse large B-cell lymphoma (DLBCL): a retrospective cohort study using CMS 100% Medicare database. Presented at: AMCP Nexus 2021; Denver, Colorado; October 18-21, 2021. Abstract C37.

2. Marziarz R, Liu Q, Lee S, et al. Real-world healthcare resource utilization and costs associated with tisagenlecleucel and axicabtagene ciloleucel among patients with diffuse large B-cell lymphoma: an analysis of hospital data. Presented at: AMCP Nexus 2021; Denver, Colorado; October 18-21, 2021. Abstract C49.